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Individual

CORNELL LEON JEFFERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4915 E RUSSELL RD APT 125, LAS VEGAS, NV 89120-2387
(702) 788-0091
Mailing address
4915 E RUSSELL RD APT 125, LAS VEGAS, NV 89120-2387
(702) 788-0091

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
320800000X
NV

Other

Enumeration date
05/11/2012
Last updated
05/11/2012
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