Provider Demographics
NPI:1447364484
Name:LAFREDO, LYANNA JOY (MD)
Entity type:Individual
Prefix:
First Name:LYANNA JOY
Middle Name:
Last Name:LAFREDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYANNA JOY
Other - Middle Name:SIA
Other - Last Name:YUCHONGTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-2315
Mailing Address - Fax:702-895-1014
Practice Address - Street 1:1524 PINTO LN FL 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4195
Practice Address - Country:US
Practice Address - Phone:702-944-2828
Practice Address - Fax:702-944-2852
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42300208000000X
SC29421208000000X
NV19364208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics