MEDICARE: ERNEST PAUL TINNIN JR.

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	225400000X	Rehabilitation Practitioner
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1366743023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST PAUL TINNIN JR.

Provider Business Mailing Address
First Line	:	3440 E RUSSELL RD # 211
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-960-5484
Fax Number	:	702-214-4289

Provider Business Practice Location Address
First Line	:	3440 E RUSSELL RD # 211
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-646-5437
Fax Number	:	702-396-4193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	01/16/2020

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