1326811662 NPI number — MRS. TYNISIA K AJIMATI RBT

Table of content: MRS. TYNISIA K AJIMATI RBT (NPI 1326811662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326811662 NPI number — MRS. TYNISIA K AJIMATI RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AJIMATI
Provider First Name:
TYNISIA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDWARDS-BARNETT
Provider Other First Name:
TYNISIA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RBT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326811662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4220 LAS VEGAS BLVD N APT 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89115-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-854-9950
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7251 W LAKE MEAD BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-8380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-387-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)