Provider Demographics
NPI:1114740107
Name:VARNADO, ROBERT L JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:VARNADO
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 1:9037 JUMPING JACKS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6288
Mailing Address - Country:US
Mailing Address - Phone:714-458-0096
Mailing Address - Fax:
Practice Address - Street 1:9037 JUMPING JACKS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-6288
Practice Address - Country:US
Practice Address - Phone:714-458-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4526106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician