MEDICARE: MELISSA CHAVEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172A00000X	Driver
2	347C00000X	Private Vehicle
3	372500000X	Chore Provider
4	372600000X	Adult Companion
5	3747P1801X	Personal Care Attendant
6	374U00000X	Home Health Aide
7	376J00000X	Homemaker

General Provider Information

NPI Number	:	1790234961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CHAVEZ

Provider Business Mailing Address
First Line	:	5613 GRAND GUINESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1366
Country	:	US
Telephone Number	:	702-443-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	5613 GRAND GUINESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1366
Country	:	US
Telephone Number	:	702-443-1105
Fax Number	:

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

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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Directions to “ MELISSA CHAVEZ ” Practice Location

Language	Start Address	Practice Location

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