Provider Demographics
NPI:1558847426
Name:MADRUGA COELLO, YOLEXI
Entity Type:Individual
Prefix:
First Name:YOLEXI
Middle Name:
Last Name:MADRUGA COELLO
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 1:4262 LASHA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0584
Mailing Address - Country:US
Mailing Address - Phone:702-606-4537
Mailing Address - Fax:
Practice Address - Street 1:2235 E FLAMINGO RD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0806
Practice Address - Country:US
Practice Address - Phone:702-606-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2105149286OtherDL