Provider Demographics
NPI:1922586247
Name:SHIMADA, MARK Y (PEER RECOVER SPECIAL)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:Y
Last Name:SHIMADA
Suffix:
Gender:M
Credentials:PEER RECOVER SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 S RAINBOW BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5100
Mailing Address - Country:US
Mailing Address - Phone:702-478-7444
Mailing Address - Fax:702-478-7864
Practice Address - Street 1:2655 S RAINBOW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5100
Practice Address - Country:US
Practice Address - Phone:702-478-7444
Practice Address - Fax:702-478-7864
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician