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NPI Code Detail

MEDICARE: MISS DASARAY JACKSON

MEDICARE: MISS DASARAY JACKSON
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
1106S00000XBehavior TechnicianRBT-16-13608AZ

General Provider Information

NPI Number : 1619477973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS DASARAY JACKSON
Provider Business Mailing Address
First Line : 3201 W DESERT COVE AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-4211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20860 N TATUM BLVD STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4283
Country : US
Telephone Number : 866-342-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2018
Last Update Date : 02/13/2018

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Directions to “ MISS DASARAY JACKSON ” Practice Location

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