Individual
ELIA DIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
417 FOXVALE AVE, NORTH LAS VEGAS, NV 89032-6150
(702) 463-0082
Mailing address
417 FOXVALE AVE, NORTH LAS VEGAS, NV 89032-6150
(702) 463-0082
(702) 643-1552
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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