Individual
JAKE DEMICHELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3530 E FLAMINGO RD, LAS VEGAS, NV 89121-5069
(702) 816-3400
Mailing address
3937 SPENCER ST APT 35, LAS VEGAS, NV 89119-5206
(845) 399-2404
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2105489707
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2105489707
—
NV
Enumeration date
09/21/2016
Last updated
09/21/2016
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