Healthcare Provider Details

I. General information

NPI: 1750665170
Provider Name (Legal Business Name): TINA M BAIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA M MOREN

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 6
LAS VEGAS NV
89102-0166
US

IV. Provider business mailing address

5865 PALMILLA ST UNIT 7
NORTH LAS VEGAS NV
89031-4131
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax:
Mailing address:
  • Phone: 510-725-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: