MEDICARE: TABA PERSONAL CARE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053772376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TABA PERSONAL CARE

Provider Business Mailing Address
First Line	:	5160 S EASTERN AVE
Second Line	:	SUITE F
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2376
Country	:	US
Telephone Number	:	702-353-0602
Fax Number	:	702-724-0585

Provider Business Practice Location Address
First Line	:	5160 S EASTERN AVE
Second Line	:	SUITE F
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2376
Country	:	US
Telephone Number	:	702-353-0602
Fax Number	:	702-724-0585

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MIRIAM NALLELY PERDOMO-AGUILAR
Credential	:
Telephone Number	:	702-353-0602

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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