Provider Demographics
NPI:1336492701
Name:RICHBOW, ANTOINETTE TOY
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:TOY
Last Name:RICHBOW
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 1:9781 DOTTIE JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6766
Mailing Address - Country:US
Mailing Address - Phone:313-212-6733
Mailing Address - Fax:
Practice Address - Street 1:9781 DOTTIE JEWEL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6766
Practice Address - Country:US
Practice Address - Phone:313-212-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health