Basic Information
| Provider Information | |||||||||
| NPI: | 1487965182 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YAMBOLIEV | ||||||||
| FirstName: | ILIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 CENTERVIEW DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 MEDICAL PKWY | ||||||||
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| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897034625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754458000 | ||||||||
| FaxNumber: | 7754458368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2010 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.