Provider Demographics
NPI:1861434425
Name:YAPHET, MARCO M (CRNA)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:M
Last Name:YAPHET
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903
Mailing Address - Country:US
Mailing Address - Phone:915-577-0111
Mailing Address - Fax:915-533-2568
Practice Address - Street 1:4311 E LOHMAN AVE
Practice Address - Street 2:MOUNTAIN VIEW REGIONAL MED CENTER
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-556-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO656711367500000X
TX041709367500000X
AZCRNA283860207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166377501Medicaid
CO25035274Medicaid
CO25035274Medicaid
S00126Medicare UPIN
CO804898Medicare ID - Type Unspecified