MEDICARE: FELIPE JERUSALEM VITAL 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	:	1043172299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE JERUSALEM VITAL JR.

Provider Business Mailing Address
First Line	:	2776 CRAIGMILLAR ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 CRAIGMILLAR ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0232
Country	:	US
Telephone Number	:	702-224-4259
Fax Number	:

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

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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