Provider Demographics
NPI:1083114185
Name:RAY, TAADHIMEKA J
Entity Type:Individual
Prefix:
First Name:TAADHIMEKA
Middle Name:J
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N. MARTIN LUTHER KING BLVD
Mailing Address - Street 2:211
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89302
Mailing Address - Country:US
Mailing Address - Phone:909-258-0939
Mailing Address - Fax:
Practice Address - Street 1:3925 N. MARTIN LUTHER KING BLVD
Practice Address - Street 2:211
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89302
Practice Address - Country:US
Practice Address - Phone:909-258-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health