Provider Demographics
NPI:1386152148
Name:TAPIA, KENISHA RENEA (DO)
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:RENEA
Last Name:TAPIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:702-916-6906
Mailing Address - Fax:
Practice Address - Street 1:9260 W SUNSET RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-916-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2023-01-27
Deactivation Date:2022-04-04
Deactivation Code:
Reactivation Date:2022-05-02
Provider Licenses
StateLicense IDTaxonomies
CA00004275106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician