Provider Demographics
NPI:1215436456
Name:GAINZA DESPAIGNE, YORDANIS
Entity type:Individual
Prefix:
First Name:YORDANIS
Middle Name:
Last Name:GAINZA DESPAIGNE
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 1:4715 VEGAS VALLEY DR UNIT 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7943
Mailing Address - Country:US
Mailing Address - Phone:832-803-7675
Mailing Address - Fax:
Practice Address - Street 1:4715 VEGAS VALLEY DR UNIT 17
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7943
Practice Address - Country:US
Practice Address - Phone:832-803-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2103263894OtherDRIVER LICENSE