MEDICARE: MR. JOSE LUIS MEDINA III

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	NV
2	3747P1801X	Personal Care Attendant	NV
3	372600000X	Adult Companion	NV
4	3747A0650X	Attendant Care Provider	NV
5	373H00000X	Day Training/Habilitation Specialist	NV
6	376J00000X	Homemaker	NV
7	385H00000X	Respite Care	NV

General Provider Information

NPI Number	:	1588594626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE LUIS MEDINA III

Provider Business Mailing Address
First Line	:	4013 MONTEBELLO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3215
Country	:	US
Telephone Number	:	702-241-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 MONTEBELLO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3215
Country	:	US
Telephone Number	:	702-241-5383
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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