Provider Demographics
NPI:1265215669
Name:TAYLOR-CUBIAS, DEIDRA KIOMONI
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:KIOMONI
Last Name:TAYLOR-CUBIAS
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 1:2663 S DECATUR BLVD APT 1079
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8538
Mailing Address - Country:US
Mailing Address - Phone:708-227-8205
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5123
Practice Address - Country:US
Practice Address - Phone:702-405-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner