Provider Demographics
NPI:1619734340
Name:RUIZ-CASTILLO, KATI ROSELYN
Entity Type:Individual
Prefix:
First Name:KATI
Middle Name:ROSELYN
Last Name:RUIZ-CASTILLO
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 1:7245 BRIDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4511
Mailing Address - Country:US
Mailing Address - Phone:702-337-9396
Mailing Address - Fax:
Practice Address - Street 1:8020 PINYON RIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-6580
Practice Address - Country:US
Practice Address - Phone:702-904-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4084106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician