Provider Demographics
NPI:1497144869
Name:URENA-ARCHULETA, YAHEIRY (PAC)
Entity Type:Individual
Prefix:
First Name:YAHEIRY
Middle Name:
Last Name:URENA-ARCHULETA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:YAHEIRY
Other - Middle Name:
Other - Last Name:URENA-PARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1679 FRAMINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2473
Mailing Address - Country:US
Mailing Address - Phone:702-409-6063
Mailing Address - Fax:
Practice Address - Street 1:1050 W GALLERIA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4800
Practice Address - Country:US
Practice Address - Phone:702-963-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52246363A00000X
NVPA1881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant