MEDICARE: LEIDYS HERNANDEZ MACEDA

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11852957483	OTHER	NV	DL

General Provider Information

NPI Number	:	1134690068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIDYS HERNANDEZ MACEDA

Provider Business Mailing Address
First Line	:	6229 OLD TRAIL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2530
Country	:	US
Telephone Number	:	702-986-1640
Fax Number	:

Provider Business Practice Location Address
First Line	:	6229 OLD TRAIL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2530
Country	:	US
Telephone Number	:	702-986-1640
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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Directions to “ LEIDYS HERNANDEZ MACEDA ” Practice Location

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