Individual
MISS JOLICA MARIE GERONIMO DOMDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2770 S MARYLAND PKWY STE 211, LAS VEGAS, NV 89109-1565
(702) 675-3400
Mailing address
2770 S MARYLAND PKWY STE 211, LAS VEGAS, NV 89109-1565
(702) 675-3400
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1603605792
NV DRIVER LICENSE
NV
Enumeration date
05/21/2012
Last updated
05/21/2012
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