Provider Demographics
NPI:1841596731
Name:JENKINS, ILLYAS MALIK
Entity Type:Individual
Prefix:MR
First Name:ILLYAS
Middle Name:MALIK
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 SUNNYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7986
Mailing Address - Country:US
Mailing Address - Phone:954-380-0875
Mailing Address - Fax:
Practice Address - Street 1:3450 W CHEYENNE AVE STE 300
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8223
Practice Address - Country:US
Practice Address - Phone:954-380-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor