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NPI Code Detail

MEDICARE: JACQUELYN ABAH

MEDICARE: JACQUELYN ABAH
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1053661868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN ABAH
Provider Business Mailing Address
First Line : 6172 BRIDGEPORT HILLS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-6837
Country : US
Telephone Number : 702-601-3767
Fax Number :
Provider Business Practice Location Address
First Line : 6172 BRIDGEPORT HILLS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-6837
Country : US
Telephone Number : 702-601-3767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/19/2012

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Directions to “ JACQUELYN ABAH ” Practice Location

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