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General NPI Number Information
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NPI Number | 1043793219
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Entity Type | Individual
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Provider Name | LAURA ELENA LARRALDE-YCHUSTE
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 4628 GREY HERON DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-2634
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Country | US
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Telephone | 702-281-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 4628 GREY HERON DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-2634
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Country | US
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Telephone | 702-281-9417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 2101827402
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License Number State | NV
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