MEDICARE: OMAR LUTAS

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	374U00000X	Home Health Aide	47993601	PA

General Provider Information

NPI Number	:	1558985333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR LUTAS

Provider Business Mailing Address
First Line	:	135 S SPRINGFIELD RD UNIT 101
Second Line	:
City	:	CLIFTON HEIGHTS
State	:	PA
Zip	:	19018-2343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 S SPRINGFIELD RD UNIT 101
Second Line	:
City	:	CLIFTON HEIGHTS
State	:	PA
Zip	:	19018-2343
Country	:	US
Telephone Number	:	267-394-1621
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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Directions to “ OMAR LUTAS ” Practice Location

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