Provider Demographics
NPI:1790302834
Name:WEINTRAUB, ELVIRA YESSICA
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:YESSICA
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:YESSICA
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1372 HAVEN GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4846
Mailing Address - Country:US
Mailing Address - Phone:702-708-3320
Mailing Address - Fax:
Practice Address - Street 1:1372 HAVEN GREEN CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4846
Practice Address - Country:US
Practice Address - Phone:702-708-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT1252OtherNEVADA REGISTRY