Provider Demographics
NPI:1063001204
Name:PUERTAS CARPIO, ROHALVIS
Entity Type:Individual
Prefix:
First Name:ROHALVIS
Middle Name:
Last Name:PUERTAS CARPIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KOVAL LN APT 34D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-6949
Mailing Address - Country:US
Mailing Address - Phone:702-426-8774
Mailing Address - Fax:
Practice Address - Street 1:4660 S EASTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6139
Practice Address - Country:US
Practice Address - Phone:252-065-8207
Practice Address - Fax:725-206-5824
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician