Healthcare Provider Details

I. General information

NPI: 1558953794
Provider Name (Legal Business Name): YENTL SERRANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 VILLAGE CENTER CIR # 100
LAS VEGAS NV
89134-6369
US

IV. Provider business mailing address

1875 VILLAGE CENTER CIR # 100
LAS VEGAS NV
89134-6369
US

V. Phone/Fax

Practice location:
  • Phone: 702-529-0699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: YENTL SERRANO
Title or Position: APPLIED CLINICAL NUTRITIONIST
Credential:
Phone: 702-529-0699