MEDICARE: JOHN CARLOS COELLO

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	:	1881275618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CARLOS COELLO

Provider Business Mailing Address
First Line	:	5040 HAYWARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 HAYWARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6823
Country	:	US
Telephone Number	:	702-475-0094
Fax Number	:

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

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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Directions to “ JOHN CARLOS COELLO ” Practice Location

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