Provider Demographics
NPI:1780203240
Name:GONZALEZ FERNANDEZ, ALAIN (QBA)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:GONZALEZ FERNANDEZ
Suffix:
Gender:M
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4709
Mailing Address - Country:US
Mailing Address - Phone:702-665-9554
Mailing Address - Fax:
Practice Address - Street 1:4714 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4709
Practice Address - Country:US
Practice Address - Phone:702-665-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician