Provider Demographics
NPI:1831143684
Name:TREHAN, MANJU MONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJU
Middle Name:MONIKA
Last Name:TREHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 W CHARLESTON BLVD
Mailing Address - Street 2:2-278
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:310-968-0447
Mailing Address - Fax:702-877-3376
Practice Address - Street 1:653 TOWN CENTER DRIVE
Practice Address - Street 2:400
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-343-3522
Practice Address - Fax:702-877-3376
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11042207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507842Medicaid
NV101994Medicare ID - Type Unspecified
NV100507842Medicaid