Provider Demographics
NPI:1952706715
Name:MUZQUIZ, ROBERTO JR
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MUZQUIZ
Suffix:JR
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 1:5021 ALTA DR.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3937
Mailing Address - Country:US
Mailing Address - Phone:702-816-2595
Mailing Address - Fax:702-816-2574
Practice Address - Street 1:5017 ALTA DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3937
Practice Address - Country:US
Practice Address - Phone:702-816-2595
Practice Address - Fax:702-816-2574
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst