Provider Demographics
NPI:1437858404
Name:BASHARZAD, NAZANIN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:NAZANIN
Middle Name:
Last Name:BASHARZAD
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 1:1091 S CIMARRON RD STE A4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2445
Mailing Address - Country:US
Mailing Address - Phone:702-992-7908
Mailing Address - Fax:
Practice Address - Street 1:1091 S CIMARRON RD STE A4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2445
Practice Address - Country:US
Practice Address - Phone:702-992-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician