Provider Demographics
NPI:1871540492
Name:TAGUBA, EMMANUEL V (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:V
Last Name:TAGUBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2031 MCDANIEL ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6303
Mailing Address - Country:US
Mailing Address - Phone:702-642-1409
Mailing Address - Fax:702-642-3675
Practice Address - Street 1:2031 MCDANIEL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6303
Practice Address - Country:US
Practice Address - Phone:702-642-1409
Practice Address - Fax:702-642-3675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF53885Medicare UPIN