Provider Demographics
NPI:1740767854
Name:GOMEZ MENENDEZ, YASMINA
Entity Type:Individual
Prefix:
First Name:YASMINA
Middle Name:
Last Name:GOMEZ MENENDEZ
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 1:4201 FULTON PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4118
Mailing Address - Country:US
Mailing Address - Phone:702-485-9066
Mailing Address - Fax:
Practice Address - Street 1:4201 FULTON PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4118
Practice Address - Country:US
Practice Address - Phone:702-485-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant