Provider Demographics
NPI:1043793219
Name:LARRALDE-YCHUSTE, LAURA ELENA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELENA
Last Name:LARRALDE-YCHUSTE
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 1:4628 GREY HERON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2634
Mailing Address - Country:US
Mailing Address - Phone:702-281-9417
Mailing Address - Fax:
Practice Address - Street 1:4628 GREY HERON DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2634
Practice Address - Country:US
Practice Address - Phone:702-281-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21018274023747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant