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General NPI Number Information
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NPI Number | 1053912758
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Entity Type | Individual
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Provider Name | DIAMOND F JACOBS LSWP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 11/08/2020
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Provider Practice Location Address
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Address Line | 1311 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89104-3309
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Country | US
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Telephone | 702-748-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 7637 ROSEBARK CLIFFS ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-4728
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Country | US
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Telephone | 314-477-4034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1378P-S
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License Number State | NV
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