Provider Demographics
NPI:1508355157
Name:MAESTAS, BRYANN
Entity Type:Individual
Prefix:
First Name:BRYANN
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S GREEN VALLEY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3145
Mailing Address - Country:US
Mailing Address - Phone:800-615-2361
Mailing Address - Fax:
Practice Address - Street 1:170 S GREEN VALLEY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3145
Practice Address - Country:US
Practice Address - Phone:800-615-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst