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NPI Code Detail

MEDICARE: YIDANYS CHALA BS, LMT, MMP

MEDICARE: YIDANYS CHALA BS, LMT, MMP
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
1225700000XMassage TherapistNVMT.6195NV

General Provider Information

NPI Number : 1538720974
Entity Type Code : Individual
Provider Name (Legal Business Name) : YIDANYS CHALA BS, LMT, MMP
Provider Business Mailing Address
First Line : PO BOX 335732
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89033-5732
Country : US
Telephone Number : 702-280-5755
Fax Number :
Provider Business Practice Location Address
First Line : 3820 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-2228
Country : US
Telephone Number : 702-818-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 06/26/2019

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