Healthcare Provider Details

I. General information

NPI: 1720580012
Provider Name (Legal Business Name): YAJAIRA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 N RANCHO DR STE 150
LAS VEGAS NV
89130-3439
US

IV. Provider business mailing address

4325 N RANCHO DR STE 150
LAS VEGAS NV
89130-3439
US

V. Phone/Fax

Practice location:
  • Phone: 702-820-8891
  • Fax:
Mailing address:
  • Phone: 702-820-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1736091
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: