MEDICARE: RICARDO EMMANUEL LIMON JR.

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

General Provider Information

NPI Number	:	1700354032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO EMMANUEL LIMON JR.

Provider Business Mailing Address
First Line	:	6133 RIVER CROSS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-3159
Country	:	US
Telephone Number	:	817-637-2823
Fax Number	:

Provider Business Practice Location Address
First Line	:	6133 RIVER CROSS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-3159
Country	:	US
Telephone Number	:	817-637-2823
Fax Number	:

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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