Provider Demographics
NPI:1538720974
Name:CHALA, YIDANYS (BS, LMT, MMP)
Entity type:Individual
Prefix:
First Name:YIDANYS
Middle Name:
Last Name:CHALA
Suffix:
Gender:F
Credentials:BS, LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335732
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89033-5732
Mailing Address - Country:US
Mailing Address - Phone:702-280-5755
Mailing Address - Fax:
Practice Address - Street 1:3820 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2228
Practice Address - Country:US
Practice Address - Phone:702-818-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.6195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist