Provider Demographics
NPI:1235676610
Name:MARTINEAU, KYLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MARTINEAU
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:303
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-259-1228
Mailing Address - Fax:702-259-1252
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:303
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:702-259-1252
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-03-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant