MEDICARE: JORGE LUIS ACOSTA VEGA

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	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457973638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS ACOSTA VEGA

Provider Business Mailing Address
First Line	:	5285 TIPPER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6964
Country	:	US
Telephone Number	:	702-542-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	5285 TIPPER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6964
Country	:	US
Telephone Number	:	702-542-6017
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	02/11/2022

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Directions to “ JORGE LUIS ACOSTA VEGA ” Practice Location

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