Provider Demographics
NPI:1942552666
Name:TEJADA-CHAVEZ, KENNETH AARON
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:AARON
Last Name:TEJADA-CHAVEZ
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 1:3853 LANCOME ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2423
Mailing Address - Country:US
Mailing Address - Phone:702-722-7428
Mailing Address - Fax:
Practice Address - Street 1:3853 LANCOME ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2423
Practice Address - Country:US
Practice Address - Phone:702-722-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner