MEDICARE: TAITEONA L IRVIN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1386310886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAITEONA L IRVIN

Provider Business Mailing Address
First Line	:	3770 UNIVERSITY CENTER DR APT C202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7595
Country	:	US
Telephone Number	:	702-292-7488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E TROPICANA AVE
Second Line	:	STE 199
City	:	LAS VEGAS
State	:	NV
Zip	:	89119
Country	:	US
Telephone Number	:	725-214-7776
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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Directions to “ TAITEONA L IRVIN ” Practice Location

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