Provider Demographics
NPI:1639875412
Name:ROYBAL, NATHAN AMADEO (RBT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:AMADEO
Last Name:ROYBAL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 S DURANGO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1779
Mailing Address - Country:US
Mailing Address - Phone:888-505-1637
Mailing Address - Fax:
Practice Address - Street 1:5980 S DURANGO DR STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1779
Practice Address - Country:US
Practice Address - Phone:888-505-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-23-255950106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician