MEDICARE: ALEJANDRO CREMATA VELAZQUEZ

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	:	1770185076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO CREMATA VELAZQUEZ

Provider Business Mailing Address
First Line	:	2350 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3103
Country	:	US
Telephone Number	:	702-510-9982
Fax Number	:	702-920-8270

Provider Business Practice Location Address
First Line	:	5050 TAMARUS ST APT 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2036
Country	:	US
Telephone Number	:	702-502-8145
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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