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1336762525 NPI number — MASHIKO JENNY TAVARES M.D., MPH. R.S.T

NPI Number: 1336762525
Health Care Provider/Practitioner: MASHIKO JENNY TAVARES M.D., MPH. R.S.T

Information about “1336762525” NPI (MASHIKO JENNY TAVARES M.D., MPH. R.S.T) exists in 1336762525 in HTML format HTML  |  1336762525 in plain Text format TXT  |  1336762525 in PDF (Portable Document Format) PDF  |  1336762525 in an XML format XML  formats.

NPI Number : 1336762525 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336762525",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAVARES",
    "FirstName": "MASHIKO",
    "MiddleName": "JENNY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D., MPH. R.S.T",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LEKANA",
    "OtherFirstName": "MASHIKO",
    "OtherMiddleName": "JENNY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "45 SUNGLOW LANE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89135",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-355-7822",
    "MailingAddressFaxNumber": "702-304-8255",
    "FirstLinePracticeLocationAddress": "1711 SONGLIGHT COURT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89117",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-450-1120",
    "PracticeLocationAddressFaxNumber": "702-304-8255",
    "EnumerationDate": "05/21/2020",
    "LastUpdateDate": "05/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "173F00000X",
        "TaxonomyName": "Sleep Specialist (PhD)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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