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NPI Code Detail

MEDICARE: LARCY MARIE JIMENEZ ACCOUNTIUS

MEDICARE: LARCY MARIE JIMENEZ ACCOUNTIUS
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1548723950
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARCY MARIE JIMENEZ ACCOUNTIUS
Provider Business Mailing Address
First Line : 4955 S DURANGO DR STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-1054
Country : US
Telephone Number : 702-871-2273
Fax Number :
Provider Business Practice Location Address
First Line : 4955 S DURANGO DR STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-1054
Country : US
Telephone Number : 702-871-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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