1548527609 NPI number — MRS. PAMELA MARANAN PARKER M.ED, LBA, BCBA

Table of content: MRS. PAMELA MARANAN PARKER M.ED, LBA, BCBA (NPI 1548527609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548527609 NPI number — MRS. PAMELA MARANAN PARKER M.ED, LBA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
PAMELA
Provider Middle Name:
MARANAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LBA, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
PAMELA
Provider Other Middle Name:
MARANAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED, LBA, BCBA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548527609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/02/2018
NPI Reactivation Date:
11/28/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8076 W SAHARA AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-829-8929
Provider Business Mailing Address Fax Number:
702-829-8948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8076 W SAHARA AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-7931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-829-8929
Provider Business Practice Location Address Fax Number:
702-829-8948
Provider Enumeration Date:
04/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-20-42200 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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