Provider Demographics
NPI:1700424348
Name:COBOS, KIMBERLY (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:COBOS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CAMINO MIRADA
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1093
Mailing Address - Country:US
Mailing Address - Phone:702-287-6872
Mailing Address - Fax:
Practice Address - Street 1:3850 W ANN RD STE 120
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4407
Practice Address - Country:US
Practice Address - Phone:702-323-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT1023106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-102654OtherBEHAVIOR ANALYST CERTIFICATION BOARD
NVRBT1023OtherNEVADA AGING AND DISABILITY SERVICES