MEDICARE: JUDY HORTILLOSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	376J00000X	Homemaker
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1760109086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY HORTILLOSO

Provider Business Mailing Address
First Line	:	3712 TABOR AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7445
Country	:	US
Telephone Number	:	702-677-2936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7441
Country	:	US
Telephone Number	:	702-955-0267
Fax Number	:

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

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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Directions to “ JUDY HORTILLOSO ” Practice Location

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