MEDICARE: SHAQUITA JONES MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1053617332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQUITA JONES MED

Provider Business Mailing Address
First Line	:	4066 RIDGEWOOD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 S JONES BLVD
Second Line	:	101
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5631
Country	:	US
Telephone Number	:	702-685-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/03/2011

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1124304696 — MRS. NINA WEISS
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Directions to “ SHAQUITA JONES MED” Practice Location

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