MEDICARE: JESSICA MORENO

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	00	NV

General Provider Information

NPI Number	:	1942841150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MORENO

Provider Business Mailing Address
First Line	:	2881 S VALLEY VIEW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0100
Country	:	US
Telephone Number	:	702-253-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	5576 W ROCHELLE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3410
Country	:	US
Telephone Number	:	702-239-4941
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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Directions to “ JESSICA MORENO ” Practice Location

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