MEDICARE: ROLANDO LOPEZ

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	:	1376355602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLANDO LOPEZ

Provider Business Mailing Address
First Line	:	1650 E SAHARA AVE STE 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3495
Country	:	US
Telephone Number	:	702-769-0584
Fax Number	:	702-836-0972

Provider Business Practice Location Address
First Line	:	4233 TARA AVE APT 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-7483
Country	:	US
Telephone Number	:	702-792-0111
Fax Number	:	702-836-0972

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

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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Directions to “ ROLANDO LOPEZ ” Practice Location

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