Provider Demographics
NPI:1003102823
Name:MASANGKAY, LYLE MYTZLE A (CRT, RRT)
Entity Type:Individual
Prefix:
First Name:LYLE MYTZLE
Middle Name:A
Last Name:MASANGKAY
Suffix:
Gender:M
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 WINTER WREN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3540
Mailing Address - Country:US
Mailing Address - Phone:702-461-1079
Mailing Address - Fax:
Practice Address - Street 1:3611 WINTER WREN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3540
Practice Address - Country:US
Practice Address - Phone:702-461-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV121497227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered