Provider Demographics
NPI:1083998876
Name:MCGINTY-JIMENEZ, TAVA
Entity Type:Individual
Prefix:
First Name:TAVA
Middle Name:
Last Name:MCGINTY-JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 HARVEST DANCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2064
Mailing Address - Country:US
Mailing Address - Phone:702-267-0721
Mailing Address - Fax:
Practice Address - Street 1:6107 HARVEST DANCE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2064
Practice Address - Country:US
Practice Address - Phone:702-267-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner