MEDICARE: UNIMAX CONSULTATION GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1174928360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIMAX CONSULTATION GROUP

Provider Business Mailing Address
First Line	:	770 WEST LONE MOUNTAIN ROAD
Second Line	:	1023
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	702-218-6271
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 WEST LONE MOUNTAIN ROAD
Second Line	:	1023
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	702-218-6271
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER/FOUNDER
Name	:	MR. ILLYAS MALIK JENKINS
Credential	:	BA, QMHA
Telephone Number	:	702-218-6271

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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