Provider Demographics
NPI:1699191874
Name:TIENCHAROEN, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TIENCHAROEN
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 1:2870 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-5031
Mailing Address - Country:US
Mailing Address - Phone:702-380-1060
Mailing Address - Fax:702-380-1081
Practice Address - Street 1:2870 S MARYLAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-5031
Practice Address - Country:US
Practice Address - Phone:702-380-1060
Practice Address - Fax:702-380-1081
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC2294227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVDU0139OtherRAILROAD MEDICARE
NV1702161Medicaid
NVCG779AMedicare PIN