MEDICARE: MR. RAYMOND M AMEJKO

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1073852596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND M AMEJKO

Provider Business Mailing Address
First Line	:	525 HARRIS ST APT 423
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-6166
Country	:	US
Telephone Number	:	702-762-2803
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 E HARMON AVE
Second Line	:	C-19
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6058
Country	:	US
Telephone Number	:	702-595-8392
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	03/05/2021

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