Provider Demographics
NPI:1336762525
Name:TAVARES, MASHIKO JENNY (MD, MPH RST)
Entity type:Individual
Prefix:DR
First Name:MASHIKO
Middle Name:JENNY
Last Name:TAVARES
Suffix:
Gender:F
Credentials:MD, MPH RST
Other - Prefix:
Other - First Name:MASHIKO
Other - Middle Name:JENNY
Other - Last Name:LEKANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 SUNGLOW LANE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-355-7822
Mailing Address - Fax:702-304-8255
Practice Address - Street 1:1711 SONGLIGHT COURT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-450-1120
Practice Address - Fax:702-304-8255
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173F00000XOther Service ProvidersSleep Specialist, PhD