MEDICARE: IVET ALDABA-VALERA SWK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	104100000X	Social Worker	8122-S	NV

General Provider Information

NPI Number	:	1043506363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVET ALDABA-VALERA SWK

Provider Business Mailing Address
First Line	:	1515 E TROPICANA AVE STE 580
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6517
Country	:	US
Telephone Number	:	702-898-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6517
Country	:	US
Telephone Number	:	702-898-5311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	04/23/2020

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