Provider Demographics
NPI:1366013070
Name:PEREZ, BOGARD (RBT)
Entity type:Individual
Prefix:
First Name:BOGARD
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 OBERLANDER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3460
Mailing Address - Country:US
Mailing Address - Phone:725-287-7219
Mailing Address - Fax:
Practice Address - Street 1:1050 E FLAMINGO RD # S107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7427
Practice Address - Country:US
Practice Address - Phone:725-234-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-166273106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician