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NPI Code Detail

MEDICARE: SAMANTHA JOY JASA

MEDICARE: SAMANTHA JOY JASA
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
1103K00000XBehavior AnalystLBA0097NV

General Provider Information

NPI Number : 1063936003
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JOY JASA
Provider Business Mailing Address
First Line : 11908 ALAVA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-4567
Country : US
Telephone Number : 702-688-3230
Fax Number :
Provider Business Practice Location Address
First Line : 5550 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-2334
Country : US
Telephone Number : 702-877-2520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 08/01/2017

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