Provider Demographics
NPI:1861868374
Name:SAN PEDRO AVILE, YANET
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:SAN PEDRO AVILE
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 1:5306 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0156
Mailing Address - Country:US
Mailing Address - Phone:702-673-7048
Mailing Address - Fax:
Practice Address - Street 1:5306 SANDSTONE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142
Practice Address - Country:US
Practice Address - Phone:702-673-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner