MEDICARE: ERICK ALEXANDER MELGAR

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000082828	OTHER	NV	DRIVERS LICENSE

General Provider Information

NPI Number	:	1386266609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK ALEXANDER MELGAR

Provider Business Mailing Address
First Line	:	1804 SNUGHAVEN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2542
Country	:	US
Telephone Number	:	702-583-0336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 SNUGHAVEN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2542
Country	:	US
Telephone Number	:	702-583-0336
Fax Number	:

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

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	05/08/2020

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