MEDICARE: MELVIS DOMINGUEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	3747A0650X	Attendant Care Provider
3	376J00000X	Homemaker
4	385H00000X	Respite Care

General Provider Information

NPI Number	:	1972383461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIS DOMINGUEZ

Provider Business Mailing Address
First Line	:	4469 DON QUIXOTE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6942
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4469 DON QUIXOTE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6942
Country	:	US
Telephone Number	:	702-758-6001
Fax Number	:

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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Directions to “ MELVIS DOMINGUEZ ” Practice Location

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