MEDICARE: SANDRA FAVELA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747A0650X	Attendant Care Provider
2	376J00000X	Homemaker
3	385H00000X	Respite Care
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1700659091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA FAVELA

Provider Business Mailing Address
First Line	:	1331 SILVER LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 SILVER LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1155
Country	:	US
Telephone Number	:	702-927-3392
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “ SANDRA FAVELA ” Practice Location

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