MEDICARE: MR. ILLYAS MALIK JENKINS

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	:	1841596731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ILLYAS MALIK JENKINS

Provider Business Mailing Address
First Line	:	5423 SUNNYVILLE ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7986
Country	:	US
Telephone Number	:	954-380-0875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W CHEYENNE AVE STE 300
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-8223
Country	:	US
Telephone Number	:	954-380-0875
Fax Number	:

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

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	03/12/2020

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