Provider Demographics
NPI:1992343123
Name:RODRIGUEZ-FUENTES, ASLEY YASMANY
Entity type:Individual
Prefix:
First Name:ASLEY
Middle Name:YASMANY
Last Name:RODRIGUEZ-FUENTES
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 1:3225 S PECOS RD APT 284
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2340
Mailing Address - Country:US
Mailing Address - Phone:702-587-6750
Mailing Address - Fax:
Practice Address - Street 1:3225 S PECOS RD APT 284
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2340
Practice Address - Country:US
Practice Address - Phone:702-587-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1821520016Medicaid