MEDICARE: ELDA DE JESUS PEREZ MENDEZ

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1801478805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDA DE JESUS PEREZ MENDEZ

Provider Business Mailing Address
First Line	:	2816 WHISTLING VINES ST.
Second Line	:
City	:	LOS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-904-5758
Fax Number	:	702-915-7384

Provider Business Practice Location Address
First Line	:	4525 S SANDHILL RD UNIT 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-954-4087
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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Directions to “ ELDA DE JESUS PEREZ MENDEZ ” Practice Location

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