Provider Demographics
NPI:1083431159
Name:AMADOR CUBAS, MINDY Z
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:Z
Last Name:AMADOR CUBAS
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 1:49 W KRAFT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2596
Mailing Address - Country:US
Mailing Address - Phone:725-264-0492
Mailing Address - Fax:
Practice Address - Street 1:49 W KRAFT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2596
Practice Address - Country:US
Practice Address - Phone:725-264-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV202431790-46305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service