Provider Demographics
NPI:1700394053
Name:HERNANDEZ BENGOCHEA, YAZMIN
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:HERNANDEZ BENGOCHEA
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 1:1270 BURNHAM AVE APT 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1954
Mailing Address - Country:US
Mailing Address - Phone:782-286-8417
Mailing Address - Fax:
Practice Address - Street 1:1270 BURNHAM AVE APT 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1954
Practice Address - Country:US
Practice Address - Phone:782-286-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1605564404OtherLIMITED TERM IDENTIFICATION CARD