Provider Demographics
NPI:1144755604
Name:DE CESPEDES MOLINA, MANUEL
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:DE CESPEDES MOLINA
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 1:2850 S MARYLAND PKWY
Mailing Address - Street 2:F-104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1570
Mailing Address - Country:US
Mailing Address - Phone:702-689-0248
Mailing Address - Fax:
Practice Address - Street 1:2850 S MARYLAND PKWY
Practice Address - Street 2:F-104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1570
Practice Address - Country:US
Practice Address - Phone:702-658-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst