Healthcare Provider Details

I. General information

NPI: 1689019820
Provider Name (Legal Business Name): JOAHAN U TIOGANGCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 W ALEXANDER RD STE. 155
LAS VEGAS NV
89130-2800
US

IV. Provider business mailing address

5715 W ALEXANDER RD STE. 155
LAS VEGAS NV
89130-2800
US

V. Phone/Fax

Practice location:
  • Phone: 702-586-8693
  • Fax:
Mailing address:
  • Phone: 702-586-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: