Healthcare Provider Details

I. General information

NPI: 1508125113
Provider Name (Legal Business Name): YOLANDA ORTEGA GAMMILL RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 2ND ST STE 201
RENO NV
89502-1186
US

IV. Provider business mailing address

1155 MILL ST # MS 14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-3971
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number32956-DI-1
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number882644
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: