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General NPI Number Information
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NPI Number | 1225319031
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Entity Type | Individual
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Provider Name | JACLYN RICHARD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 3001 E LAKE DR B2221
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City | LAS VEGAS
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State | NV
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Zip | 89177-0001
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Country | US
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Telephone | 702-742-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 E LAKE DR B2221
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City | LAS VEGAS
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State | NV
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Zip | 89177-0001
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Country | US
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Telephone | 702-742-8868
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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