Community Youth Interalia
Psychologist, Exercise & Sports in Las Vegas, NV. Organization (NPI-2).
NPI number1790282002
StatusActive
Last updated in NPPESApr 12, 2018
Details
- NPI
- 1790282002
- Entity type
- Organization (NPI-2)
- Legal business name
- Community Youth Interalia
- Organization subpart
- Yes
- Enumeration date
- Apr 12, 2018
- Last updated
- Apr 12, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TE1100X | Psychologist, Exercise & Sports | 667 | NV | Yes |
Other names
- Seao Interalia (Doing Business As)
Practice location
9082 Vintage Wine AveLas Vegas, NV 89148-4916
Phone 702-328-0459
Mailing address
9082 Vintage Wine AveLas Vegas, NV 89148-4916
Phone 702-328-0459
Authorized official
Jude Niba
President
7023280459
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