Provider Demographics
NPI:1295574366
Name:NAVARRETE MENDOZA, EMMANUEL ALEXANDER
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ALEXANDER
Last Name:NAVARRETE MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10294 KADUMBA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8012
Mailing Address - Country:US
Mailing Address - Phone:702-587-8790
Mailing Address - Fax:
Practice Address - Street 1:10294 KADUMBA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-8012
Practice Address - Country:US
Practice Address - Phone:702-587-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician