MEDICARE: JEROME MORALES LAREZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	372600000X	Adult Companion
3	3747P1801X	Personal Care Attendant
4	374U00000X	Home Health Aide
5	376K00000X	Nurse's Aide
6	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1144077827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME MORALES LAREZ

Provider Business Mailing Address
First Line	:	3016 CROCKETT ST APT 424
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7933
Country	:	US
Telephone Number	:	214-263-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 WALRAVEN CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2535
Country	:	US
Telephone Number	:	214-263-7619
Fax Number	:

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “ JEROME MORALES LAREZ ” Practice Location

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