Provider Demographics
NPI:1457136996
Name:PERAZA RODRIGUEZ, ARMANDO R
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:R
Last Name:PERAZA RODRIGUEZ
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 1:1767 QUIVER POINT AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3482
Mailing Address - Country:US
Mailing Address - Phone:725-248-4640
Mailing Address - Fax:
Practice Address - Street 1:1767 QUIVER POINT AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3482
Practice Address - Country:US
Practice Address - Phone:239-888-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician