Provider Demographics
NPI:1740736206
Name:BUENAVENTURA, ALECZANDER CANON (RBT)
Entity Type:Individual
Prefix:MR
First Name:ALECZANDER
Middle Name:CANON
Last Name:BUENAVENTURA
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 1:4475 WEITZMAN PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6035
Mailing Address - Country:US
Mailing Address - Phone:702-569-5080
Mailing Address - Fax:
Practice Address - Street 1:4475 WEITZMAN PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-6035
Practice Address - Country:US
Practice Address - Phone:702-569-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-16-22929103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-16-22929OtherRBT