Provider Demographics
NPI:1124732052
Name:VIAMONTES-MARRERO, YISEL
Entity type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:VIAMONTES-MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HARBOR CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7460
Mailing Address - Country:US
Mailing Address - Phone:702-439-9071
Mailing Address - Fax:
Practice Address - Street 1:2560 S MARYLAND PKWY STE 12
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1672
Practice Address - Country:US
Practice Address - Phone:702-444-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily