Provider Demographics
NPI:1538876594
Name:TROMPETER, AVA RAQUEL
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:RAQUEL
Last Name:TROMPETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 BICENTENNIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0519
Mailing Address - Country:US
Mailing Address - Phone:702-304-4763
Mailing Address - Fax:
Practice Address - Street 1:1091 S CIMARRON RD STE A4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2445
Practice Address - Country:US
Practice Address - Phone:702-992-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician