MEDICARE: GUISSELL LOPEZ AVILEZ

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	:	1376184424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUISSELL LOPEZ AVILEZ

Provider Business Mailing Address
First Line	:	1127 EMERALD STONE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3032
Country	:	US
Telephone Number	:	702-743-1358
Fax Number	:	702-359-4623

Provider Business Practice Location Address
First Line	:	5400 W CHEYENNE AVE APT 2037
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4745
Country	:	US
Telephone Number	:	925-446-5279
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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Directions to “ GUISSELL LOPEZ AVILEZ ” Practice Location

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