Provider Demographics
NPI:1487085635
Name:PEREZ, EDGAR KEVIN
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:KEVIN
Last Name:PEREZ
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 1:1111 S CASINO CENTER BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1048
Mailing Address - Country:US
Mailing Address - Phone:702-351-6958
Mailing Address - Fax:
Practice Address - Street 1:3225 MCLEOD DR
Practice Address - Street 2:PARADISE BEHAVIROAL
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2257
Practice Address - Country:US
Practice Address - Phone:702-326-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst