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NPI Code Detail

MEDICARE: ETHAN VICTOR PALAFOX VERGARA

MEDICARE: ETHAN VICTOR PALAFOX VERGARA
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1548123136
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN VICTOR PALAFOX VERGARA
Provider Business Mailing Address
First Line : 4055 SPENCER ST STE 109
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5250
Country : US
Telephone Number : 702-937-2221
Fax Number :
Provider Business Practice Location Address
First Line : 4055 SPENCER ST STE 109
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5250
Country : US
Telephone Number : 702-937-2221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ ETHAN VICTOR PALAFOX VERGARA ” Practice Location

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