MEDICARE: AMANDA MAITE CONSTANTIN FRIAS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01528856748	OTHER	NV	ID

General Provider Information

NPI Number	:	1942847447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MAITE CONSTANTIN FRIAS

Provider Business Mailing Address
First Line	:	711 BLUE BARREL ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-2616
Country	:	US
Telephone Number	:	702-937-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 BLUE BARREL ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-2616
Country	:	US
Telephone Number	:	702-937-2848
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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