Provider Demographics
NPI:1114412715
Name:PATINO-GUZMAN, ANA LAURA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LAURA
Last Name:PATINO-GUZMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2896 PRESTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-3757
Mailing Address - Country:US
Mailing Address - Phone:702-280-3096
Mailing Address - Fax:
Practice Address - Street 1:2896 PRESTONWOOD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-3757
Practice Address - Country:US
Practice Address - Phone:702-280-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-18-58938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-18-58938OtherREGISTERED BEHAVIOR TECHNICIAN