Basic Information
| Provider Information | |||||||||
| NPI: | 1407858418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 LACANADA ST | ||||||||
| Address2: | SUITE 244 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026970082 | ||||||||
| FaxNumber: | 7026919984 | ||||||||
| Practice Location | |||||||||
| Address1: | 3186 S MARYLAND PKWY | ||||||||
| Address2: | SUNRISE CHILDRENS HOSPITAL NICU | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027318240 | ||||||||
| FaxNumber: | 7026935331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 16964 | NV | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 003760900 | 05 | ID | MEDICAID |