MEDICARE: YADAMI RIBALTA UGARTE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	3747A0650X	Attendant Care Provider
3	376J00000X	Homemaker
4	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2105211990	OTHER	NV	DRIVER LICENSE

General Provider Information

NPI Number	:	1356849889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADAMI RIBALTA UGARTE

Provider Business Mailing Address
First Line	:	2233 E HACIENDA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8002
Country	:	US
Telephone Number	:	702-980-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 E HACIENDA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8002
Country	:	US
Telephone Number	:	702-980-0074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	01/30/2018

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