MEDICARE: JORGE ALFONSO LIZAMA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747A0650X	Attendant Care Provider
2	376J00000X	Homemaker
3	385H00000X	Respite Care
4	3747P1801X	Personal Care Attendant
5	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1316726664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ALFONSO LIZAMA

Provider Business Mailing Address
First Line	:	3255 GOLD RUN ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 GOLD RUN ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3416
Country	:	US
Telephone Number	:	702-763-0272
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	08/15/2024

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Directions to “ JORGE ALFONSO LIZAMA ” Practice Location

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