MEDICARE: ADA I VERA DPM LTD

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0016	NV

General Provider Information

NPI Number	:	1649365859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADA I VERA DPM LTD

Provider Business Mailing Address
First Line	:	PO BOX 33250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3250
Country	:	US
Telephone Number	:	702-878-5252
Fax Number	:	702-878-1963

Provider Business Practice Location Address
First Line	:	3000 W CHARLESTON BLVD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1940
Country	:	US
Telephone Number	:	702-878-5252
Fax Number	:	702-878-1963

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADA I VERA
Credential	:	DPM
Telephone Number	:	702-878-5252

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/14/2018

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