Provider Demographics
NPI:1659126456
Name:VAYA, JONATHAN (BA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:VAYA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 S CIMARRON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2697
Mailing Address - Country:US
Mailing Address - Phone:702-430-7987
Mailing Address - Fax:
Practice Address - Street 1:2595 S CIMARRON RD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2697
Practice Address - Country:US
Practice Address - Phone:702-430-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner