MEDICARE: DIANA FLORES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	NV
2	372600000X	Adult Companion	NV
3	376J00000X	Homemaker	NV
4	3747P1801X	Personal Care Attendant	NV

General Provider Information

NPI Number	:	1982105193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA FLORES

Provider Business Mailing Address
First Line	:	2690 CHANDLER AVE STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10250 SPENCER ST APT 1107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-6906
Country	:	US
Telephone Number	:	702-717-4683
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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Directions to “ DIANA FLORES ” Practice Location

Language	Start Address	Practice Location

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