Provider Demographics
NPI:1518543636
Name:PORTILLO, YOLANDA YANETH
Entity Type:Individual
Prefix:
First Name:YOLANDA YANETH
Middle Name:
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 W SAHARA AVE STE 250A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0383
Mailing Address - Country:US
Mailing Address - Phone:775-513-1282
Mailing Address - Fax:
Practice Address - Street 1:5450 W SAHARA AVE STE 250A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0383
Practice Address - Country:US
Practice Address - Phone:775-513-1282
Practice Address - Fax:775-727-2085
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider