Provider Demographics
NPI:1801266713
Name:GUADALUPE GARCIA, YADISNAY
Entity type:Individual
Prefix:MS
First Name:YADISNAY
Middle Name:
Last Name:GUADALUPE GARCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E KATIE AVE UNIT S12
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8151
Mailing Address - Country:US
Mailing Address - Phone:702-742-5496
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5124
Practice Address - Country:US
Practice Address - Phone:702-680-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NV863426363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health