MEDICARE: MONIQUE TANAKA

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1376297820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE TANAKA

Provider Business Mailing Address
First Line	:	410 S RAMPART BLVD STE 390
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E AZURE AVE APT 3008
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6878
Country	:	US
Telephone Number	:	702-374-2392
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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Directions to “ MONIQUE TANAKA ” Practice Location

Language	Start Address	Practice Location

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