MEDICARE: VALLEY OF FIRE CONSULTING LLC

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	:	1174205322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY OF FIRE CONSULTING LLC

Provider Business Mailing Address
First Line	:	1515 E TROPICANA AVE STE 655
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6523
Country	:	US
Telephone Number	:	808-783-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E TROPICANA AVE STE 655
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6523
Country	:	US
Telephone Number	:	808-783-3278
Fax Number	:

Authorized Official
Title or Position	:	DON/OWNER
Name	:	EDSEL GAY PINPIN TUMBAGON MARTINEZ
Credential	:	RN
Telephone Number	:	808-783-3278

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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