Provider Demographics
NPI:1588099303
Name:DAYDA, BETHZEBA
Entity type:Individual
Prefix:
First Name:BETHZEBA
Middle Name:
Last Name:DAYDA
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 1:5328 SUMMER TROUT STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031
Mailing Address - Country:US
Mailing Address - Phone:702-493-7267
Mailing Address - Fax:
Practice Address - Street 1:5328 SUMMER TROUT ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6616
Practice Address - Country:US
Practice Address - Phone:702-493-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XMedicaid