Provider Demographics
NPI:1053690362
Name:CASTILLO GONGORA, YAMILKA (APRN)
Entity Type:Individual
Prefix:
First Name:YAMILKA
Middle Name:
Last Name:CASTILLO GONGORA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 E FLAMINGO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5175
Mailing Address - Country:US
Mailing Address - Phone:702-623-8651
Mailing Address - Fax:702-605-1744
Practice Address - Street 1:2080 E FLAMINGO RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5175
Practice Address - Country:US
Practice Address - Phone:702-623-8651
Practice Address - Fax:702-605-1744
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV827217363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health