Provider Demographics
NPI:1750665170
Name:BAIZA, TINA M
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:BAIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:MOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5865 PALMILLA ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4131
Mailing Address - Country:US
Mailing Address - Phone:510-725-7162
Mailing Address - Fax:
Practice Address - Street 1:2801 S VALLEY VIEW BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0166
Practice Address - Country:US
Practice Address - Phone:702-922-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner