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General NPI Number Information
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NPI Number | 1285988030
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Entity Type | Individual
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Provider Name | MR. JABRE D'ANTHONY JEFFERSON
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Gender | Male
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 433 KITTY HAWK RD SUITE 220
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3357
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Country | US
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Telephone | 210-566-1592
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Fax |
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Provider Business Mailing Address
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Address Line | 9623 COPPER SPRINGS
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City | COVERSE
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State | TX
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Zip | 78109
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Country | US
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Telephone | 210-566-1592
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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