Provider Demographics
NPI:1649083569
Name:NEVAREZ, JOSE ALEXIS
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEXIS
Last Name:NEVAREZ
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 1:1487 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1805
Mailing Address - Country:US
Mailing Address - Phone:702-972-1650
Mailing Address - Fax:
Practice Address - Street 1:11500 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5576
Practice Address - Country:US
Practice Address - Phone:760-856-0607
Practice Address - Fax:760-856-5007
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBACB1249103106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician