Provider Demographics
NPI:1790038859
Name:REED, TANGELA DESHEA
Entity Type:Individual
Prefix:MS
First Name:TANGELA
Middle Name:DESHEA
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANGELA
Other - Middle Name:DESHEA
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6905 COBRE AZUL AVE
Mailing Address - Street 2:6905 COBRE AZULE APT.202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-0389
Mailing Address - Country:US
Mailing Address - Phone:702-609-3601
Mailing Address - Fax:
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-778-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner