Basic Information
| Provider Information | |||||||||
| NPI: | 1720297799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONE | ||||||||
| FirstName: | TOYA | ||||||||
| MiddleName: | VENETTA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7858 TAHOE RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487947025 | ||||||||
| FaxNumber: | 7022563307 | ||||||||
| Practice Location | |||||||||
| Address1: | 7730 W CHEYENNE AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891298412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7252211568 | ||||||||
| FaxNumber: | 7253339218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 4301088006 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1720297799 | 05 | MI | MEDICAID | 1417961137 | 01 | MI | BCBSM - BRONSON | OTHER |