Provider Demographics
NPI:1992317770
Name:LOPEZ AMEZQUITA, YISY MIRIAN
Entity type:Individual
Prefix:
First Name:YISY
Middle Name:MIRIAN
Last Name:LOPEZ AMEZQUITA
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 1:5761 CLOVERLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1119
Mailing Address - Country:US
Mailing Address - Phone:702-290-7560
Mailing Address - Fax:
Practice Address - Street 1:5761 CLOVERLEAF CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1119
Practice Address - Country:US
Practice Address - Phone:702-290-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant