Provider Demographics
NPI:1730651290
Name:CANCIO, YELENIS
Entity Type:Individual
Prefix:
First Name:YELENIS
Middle Name:
Last Name:CANCIO
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 1:5968 EMERALD CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1255
Mailing Address - Country:US
Mailing Address - Phone:702-337-0764
Mailing Address - Fax:
Practice Address - Street 1:5968 EMERALD CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1255
Practice Address - Country:US
Practice Address - Phone:702-337-0764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC520-960-79-691-0OtherDL