MEDICARE: RENEW YOUR MIND LLC

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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1356042915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW YOUR MIND LLC

Provider Business Mailing Address
First Line	:	3256 CIVIC CENTER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-8101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3256 CIVIC CENTER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-8101
Country	:	US
Telephone Number	:	702-824-6353
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	YANARA SARMIENTO BARRIEL
Credential	:
Telephone Number	:	702-824-6353

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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Directions to “RENEW YOUR MIND LLC ” Practice Location

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