MEDICARE: YHASMIN QUITEVIS PANTALEON

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	225100000X	Physical Therapist	1292119	TX
2	225100000X	Physical Therapist	4636	NV

General Provider Information

NPI Number	:	1902670961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YHASMIN QUITEVIS PANTALEON

Provider Business Mailing Address
First Line	:	4865 LAMES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-1906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4865 LAMES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-1906
Country	:	US
Telephone Number	:	725-400-6383
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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Directions to “ YHASMIN QUITEVIS PANTALEON ” Practice Location

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