MEDICARE: MRS. YANITZA MARMOLEJOS VASEUR

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	235Z00000X	Speech-Language Pathologist	SP-3373	NV

General Provider Information

NPI Number	:	1700511664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YANITZA MARMOLEJOS VASEUR

Provider Business Mailing Address
First Line	:	10197 ZETA TUCANA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S RAINBOW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6214
Country	:	US
Telephone Number	:	725-290-2915
Fax Number	:

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

Provider Enumeration Date	:	07/23/2022
Last Update Date	:	03/31/2025

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