Provider Demographics
NPI:1164049722
Name:GUERRERO VILLAFANE, ALEXIS (QBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GUERRERO VILLAFANE
Suffix:
Gender:M
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 E DESERT INN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3624
Mailing Address - Country:US
Mailing Address - Phone:702-296-4844
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3624
Practice Address - Country:US
Practice Address - Phone:702-296-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician