Provider Demographics
NPI:1942187398
Name:TABRON, DEANDRE CAPRICE LERONE
Entity type:Individual
Prefix:
First Name:DEANDRE
Middle Name:CAPRICE LERONE
Last Name:TABRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 CALIFORNIA ST APT 9
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2528
Mailing Address - Country:US
Mailing Address - Phone:402-739-2952
Mailing Address - Fax:
Practice Address - Street 1:4729 CALIFORNIA ST APT 9
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2528
Practice Address - Country:US
Practice Address - Phone:402-739-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH13067076OtherDRIVERS LICENSE