Provider Demographics
NPI:1235766957
Name:ICHINOE, DENICE MARIE (DO)
Entity type:Individual
Prefix:
First Name:DENICE MARIE
Middle Name:
Last Name:ICHINOE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 N TENAYA WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0424
Mailing Address - Country:US
Mailing Address - Phone:702-992-6888
Mailing Address - Fax:
Practice Address - Street 1:2724 N TENAYA WAY FL 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-992-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3807207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine