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NPI Code Detail

MEDICARE: YAMILKA CASTILLO GONGORA APRN

MEDICARE:   YAMILKA  CASTILLO GONGORA  APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner827217NV

General Provider Information

NPI Number : 1053690362
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAMILKA CASTILLO GONGORA APRN
Provider Business Mailing Address
First Line : 2080 E FLAMINGO RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5175
Country : US
Telephone Number : 702-623-8651
Fax Number : 702-605-1744
Provider Business Practice Location Address
First Line : 2080 E FLAMINGO RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5175
Country : US
Telephone Number : 702-623-8651
Fax Number : 702-605-1744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/23/2023

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