Provider Demographics
NPI:1619092376
Name:KUBAL, VANEETA V (MD)
Entity Type:Individual
Prefix:
First Name:VANEETA
Middle Name:V
Last Name:KUBAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 VILLA CACHE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5573
Mailing Address - Country:US
Mailing Address - Phone:702-233-6403
Mailing Address - Fax:
Practice Address - Street 1:3945 W CHEYENNE AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8901
Practice Address - Country:US
Practice Address - Phone:702-648-8116
Practice Address - Fax:702-648-8259
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002109208000000X
NV12199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics