MEDICARE: LORENA HERNANDEZ MATOS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710747464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA HERNANDEZ MATOS

Provider Business Mailing Address
First Line	:	4715 VEGAS VALLEY DR UNIT 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7941
Country	:	US
Telephone Number	:	702-573-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 PLATA DEL SOL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6861
Country	:	US
Telephone Number	:	702-981-1484
Fax Number	:	702-995-0242

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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Directions to “ LORENA HERNANDEZ MATOS ” Practice Location

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