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NPI Code Detail

MEDICARE: MARIELY C GOMEZ MEJIA

MEDICARE: MARIELY C GOMEZ MEJIA
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
13747P1801XPersonal Care Attendant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12102241300OTHERNVNV DRIVER LICENSE CARD

General Provider Information

NPI Number : 1821709304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIELY C GOMEZ MEJIA
Provider Business Mailing Address
First Line : 1912 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3106
Country : US
Telephone Number : 702-331-3650
Fax Number :
Provider Business Practice Location Address
First Line : 1912 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3106
Country : US
Telephone Number : 702-331-3650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2022
Last Update Date : 12/06/2022

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Directions to “ MARIELY C GOMEZ MEJIA ” Practice Location

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