Healthcare Provider Details

I. General information

NPI: 1508140641
Provider Name (Legal Business Name): MISS JAYDE MALIA LOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY BLDG 8C
SPARKS NV
89431-5564
US

IV. Provider business mailing address

7350 SILVER LAKE RD APT 32C
RENO NV
89506-4130
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax:
Mailing address:
  • Phone: 775-846-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: