Provider Demographics
NPI:1164276317
Name:CAASI, KIMBERLY CABANSAG
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CABANSAG
Last Name:CAASI
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 1:5440 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0355
Mailing Address - Country:US
Mailing Address - Phone:702-502-8021
Mailing Address - Fax:
Practice Address - Street 1:5440 W SAHARA AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0361
Practice Address - Country:US
Practice Address - Phone:702-502-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4095106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician