Provider Demographics
NPI:1043073448
Name:OLIVAS ESTEBANE, ASAF
Entity type:Individual
Prefix:
First Name:ASAF
Middle Name:
Last Name:OLIVAS ESTEBANE
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 1:6635 CAPORETTO LN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2148
Mailing Address - Country:US
Mailing Address - Phone:970-456-8321
Mailing Address - Fax:
Practice Address - Street 1:6635 CAPORETTO LN UNIT 204
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2148
Practice Address - Country:US
Practice Address - Phone:970-456-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician