MEDICARE: MARBELIS ALVAREZ ANTUNEZ

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	:	1740866904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARBELIS ALVAREZ ANTUNEZ

Provider Business Mailing Address
First Line	:	417 FOXVALE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6150
Country	:	US
Telephone Number	:	170-261-9185
Fax Number	:	702-463-0104

Provider Business Practice Location Address
First Line	:	4150 PATTERSON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5228
Country	:	US
Telephone Number	:	702-619-1859
Fax Number	:	702-463-0104

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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