Individual
JACQUELYN ELISALDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3620 N. RANCHO DR. SUITE 113, LAS VEGAS, NV 89130-9998
(702) 362-5181
Mailing address
705 STORMCREST LN., LAS VEGAS, NV 89107-4369
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
193450A
NV
Other
Enumeration date
09/07/2012
Last updated
10/04/2012
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