MEDICARE: ROBERTO OLIVARES LUVIN

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
2	172V00000X	Community Health Worker	CHW1-5478	NV
3	106S00000X	Behavior Technician	RBT-24-347236	NV

General Provider Information

NPI Number	:	1528746922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO OLIVARES LUVIN

Provider Business Mailing Address
First Line	:	2800 S EASTERN AVE APT 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-1826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4174 RIVERSTONE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-4353
Country	:	US
Telephone Number	:	702-557-1292
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	08/27/2024

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