Individual
JESSY HERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
73 CONSTITUTION AVE, HENDERSON, NV 89015-5782
(702) 502-0244
Mailing address
73 CONSTITUTION AVE, HENDERSON, NV 89015-5782
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1704479623
—
NV
Enumeration date
11/06/2018
Last updated
11/06/2018
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