MEDICARE: AMIGO PERSONAL CARE

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	302R00000X	Health Maintenance Organization	H1496422F128570	NV

General Provider Information

NPI Number	:	1598851644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIGO PERSONAL CARE

Provider Business Mailing Address
First Line	:	5017 ALTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3937
Country	:	US
Telephone Number	:	702-878-4020
Fax Number	:	702-878-4030

Provider Business Practice Location Address
First Line	:	5017 ALTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3937
Country	:	US
Telephone Number	:	702-878-4020
Fax Number	:	702-878-4030

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VIRGEN RODRIQUEZ
Credential	:
Telephone Number	:	702-878-4020

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

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Directions to “AMIGO PERSONAL CARE ” Practice Location

Language	Start Address	Practice Location

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