MEDICARE: ROSALINE ELIZABETH QUERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225400000X	Rehabilitation Practitioner
2	172V00000X	Community Health Worker
3	174H00000X	Health Educator

General Provider Information

NPI Number	:	1588966196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALINE ELIZABETH QUERO

Provider Business Mailing Address
First Line	:	7119 S DURANGO DR
Second Line	:	#111
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2057
Country	:	US
Telephone Number	:	702-587-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 S DURANGO DR
Second Line	:	#111
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2057
Country	:	US
Telephone Number	:	702-587-2434
Fax Number	:

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

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	09/06/2012

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