Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 71 | NM |
Y | 213ES0000X | Sports Medicine | 71 | NM |
NPI | 1154894251 |
---|---|
Provider Name | Yvette R Pomponi |
First Address | Las Vegas, NM 87701-4279 |
Second Address | Las Vegas, NM 87701-4279 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 10/01/2019 |