MEDICARE: ROMULO DOMINGO LMT

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	225700000X	Massage Therapist	MAT9329	HI
2	372500000X	Chore Provider		NV
3	372600000X	Adult Companion		NV
4	3747A0650X	Attendant Care Provider		NV
5	376J00000X	Homemaker		NV
6	3747P1801X	Personal Care Attendant		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0074016270101014	OTHER	HI	GEICO

General Provider Information

NPI Number	:	1235390360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMULO DOMINGO LMT

Provider Business Mailing Address
First Line	:	2860 E FLAMINGO RD STE K
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5270
Country	:	US
Telephone Number	:	702-318-5005
Fax Number	:	702-318-5006

Provider Business Practice Location Address
First Line	:	2860 E FLAMINGO RD STE K
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5270
Country	:	US
Telephone Number	:	702-318-5005
Fax Number	:	702-318-5006

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	03/20/2024

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Directions to “ ROMULO DOMINGO LMT” Practice Location

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