Provider Demographics
NPI:1689249211
Name:PORCIUNCULA, AIREEN (RBT)
Entity Type:Individual
Prefix:
First Name:AIREEN
Middle Name:
Last Name:PORCIUNCULA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:AIREEN
Other - Middle Name:
Other - Last Name:DANLAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:981 WAGNER VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5065
Mailing Address - Country:US
Mailing Address - Phone:702-931-5523
Mailing Address - Fax:
Practice Address - Street 1:3211 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3157
Practice Address - Country:US
Practice Address - Phone:702-931-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician