Healthcare Provider Details

I. General information

NPI: 1831143684
Provider Name (Legal Business Name): MANJU MONIKA TREHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 TOWN CENTER DRIVE 400
LAS VEGAS NV
89144
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD 2-278
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 702-343-3522
  • Fax: 702-877-3376
Mailing address:
  • Phone: 310-968-0447
  • Fax: 702-877-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11042
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number11042
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number11042
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: