Basic Information
| Provider Information | |||||||||
| NPI: | 1679119747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUHANS GHEBRENDRIAS MD LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 S RANCHO DR # 4-740 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891063837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022426911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 S RANCHO DR # 4-740 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891063837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022426911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2019 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | GHEBRENDRIAS | ||||||||
| AuthorizedOfficialFirstName: | YOUHANS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5599169826 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 19125 | 01 | NV | NV MEDICAL LICENSE | OTHER |