Provider Demographics
NPI:1992009062
Name:JENKINS, TRAFORD MONTEZ
Entity Type:Individual
Prefix:MR
First Name:TRAFORD
Middle Name:MONTEZ
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 1:7955 BADURA AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2140
Mailing Address - Country:US
Mailing Address - Phone:702-353-7050
Mailing Address - Fax:
Practice Address - Street 1:3550 W CHEYENNE AVE
Practice Address - Street 2:STE 130
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8252
Practice Address - Country:US
Practice Address - Phone:702-804-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner