MEDICARE: YDALIS LEBRIJIO

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	:	1104326693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YDALIS LEBRIJIO

Provider Business Mailing Address
First Line	:	2780 S JONES BLVD STE 105B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	702-333-1488
Fax Number	:	702-933-9547

Provider Business Practice Location Address
First Line	:	4660 S EASTERN AVE STE 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6139
Country	:	US
Telephone Number	:	702-462-5251
Fax Number	:

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	03/09/2020

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Directions to “ YDALIS LEBRIJIO ” Practice Location

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