Provider Demographics
NPI:1679181796
Name:RODRIGUEZ HERNANDEZ, YANDRY
Entity Type:Individual
Prefix:
First Name:YANDRY
Middle Name:
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
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 1:3145 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2601
Mailing Address - Country:US
Mailing Address - Phone:702-748-5679
Mailing Address - Fax:
Practice Address - Street 1:4535 W RUSSELL RD STE 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2258
Practice Address - Country:US
Practice Address - Phone:702-368-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician