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General NPI Number Information
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NPI Number | 1679181796
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Entity Type | Individual
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Provider Name | YANDRY RODRIGUEZ HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 4535 W RUSSELL RD STE 15
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City | LAS VEGAS
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State | NV
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Zip | 89118-2258
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Country | US
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Telephone | 702-368-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 AVONDALE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89121-2601
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Country | US
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Telephone | 702-748-5679
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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 | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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