Provider Demographics
NPI:1669340162
Name:YILMA, MESAFENT GENENE
Entity type:Individual
Prefix:MR
First Name:MESAFENT
Middle Name:GENENE
Last Name:YILMA
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 1:1091 S CIMARRON RD STE A4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2445
Mailing Address - Country:US
Mailing Address - Phone:702-389-5465
Mailing Address - Fax:
Practice Address - Street 1:1091 S CIMARRON RD STE A4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2445
Practice Address - Country:US
Practice Address - Phone:702-389-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician