MEDICARE: MARTHA LILIA LOERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	NV
2	372600000X	Adult Companion	NV
3	3747A0650X	Attendant Care Provider	NV
4	376J00000X	Homemaker	NV
5	3747P1801X	Personal Care Attendant	NV

General Provider Information

NPI Number	:	1124381207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA LILIA LOERA

Provider Business Mailing Address
First Line	:	2733 MOON WAVE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1105
Country	:	US
Telephone Number	:	702-286-8238
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 E HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-7936
Country	:	US
Telephone Number	:	702-644-3600
Fax Number	:

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

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	05/30/2019

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Directions to “ MARTHA LILIA LOERA ” Practice Location

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