Provider Demographics
NPI:1568745735
Name:YOABOV, STEPHANY LEANN
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:LEANN
Last Name:YOABOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:LEANN
Other - Last Name:YOABOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3116 OCEANTIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9153
Mailing Address - Country:US
Mailing Address - Phone:702-426-5027
Mailing Address - Fax:
Practice Address - Street 1:750 CORONADO CENTER DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5034
Practice Address - Country:US
Practice Address - Phone:702-426-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVTBD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty