MEDICARE: GLADYS TENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	104100000X	Social Worker
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1982079919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS TENA

Provider Business Mailing Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-522-9962
Fax Number	:	702-522-9967

Provider Business Practice Location Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-522-9962
Fax Number	:	702-522-9967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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Directions to “ GLADYS TENA ” Practice Location

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