Provider Demographics
NPI:1447599337
Name:YANZON, MEYNARDO BERNARDINO JR
Entity Type:Individual
Prefix:
First Name:MEYNARDO
Middle Name:BERNARDINO
Last Name:YANZON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9490 BERMUDA RD APT 1180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3587
Mailing Address - Country:US
Mailing Address - Phone:702-606-5712
Mailing Address - Fax:
Practice Address - Street 1:9490 BERMUDA RD APT 1180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3587
Practice Address - Country:US
Practice Address - Phone:702-606-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst