MEDICARE: LUZ B. AQUINO

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	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649681123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ B. AQUINO

Provider Business Mailing Address
First Line	:	395 E WIGWAM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2247
Country	:	US
Telephone Number	:	702-250-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 E WIGWAM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2247
Country	:	US
Telephone Number	:	702-250-0388
Fax Number	:

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

Provider Enumeration Date	:	05/18/2014
Last Update Date	:	05/18/2014

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Directions to “ LUZ B. AQUINO ” Practice Location

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