Provider Demographics
NPI:1164051611
Name:MARQUETTI-VARONA, IBIANDI (QBA)
Entity Type:Individual
Prefix:
First Name:IBIANDI
Middle Name:
Last Name:MARQUETTI-VARONA
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 1:4714 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4709
Mailing Address - Country:US
Mailing Address - Phone:702-658-7770
Mailing Address - Fax:
Practice Address - Street 1:4714 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4709
Practice Address - Country:US
Practice Address - Phone:702-658-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician