Provider Demographics
NPI:1679099436
Name:GASTINEAU, DELEKIA S
Entity Type:Individual
Prefix:
First Name:DELEKIA
Middle Name:S
Last Name:GASTINEAU
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 1:29223 LEGENDS GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3583
Mailing Address - Country:US
Mailing Address - Phone:281-748-5796
Mailing Address - Fax:
Practice Address - Street 1:101 S RAINBOW BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5370
Practice Address - Country:US
Practice Address - Phone:702-778-8922
Practice Address - Fax:702-778-8789
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner