Basic Information
Provider Information
NPI: 1043790454
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA REYES
FirstName: YAMILA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3149 E DESERT INN RD APT 10
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891213833
CountryCode: US
TelephoneNumber: 7027581304
FaxNumber:  
Practice Location
Address1: 5000 W OAKEY BLVD STE E1
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891463398
CountryCode: US
TelephoneNumber: 7027332890
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/15/2018
LastUpdateDate: 08/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
3747P1801X NVN Nursing Service Related ProvidersTechnicianPersonal Care Attendant
376J00000X NVN Nursing Service Related ProvidersHomemaker 
372500000X NVY Nursing Service Related ProvidersChore Provider 

No ID Information.


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