MEDICARE: JAZMIN O'BANNON

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1477103265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMIN O'BANNON

Provider Business Mailing Address
First Line	:	1397 MINUET ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3481 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3228
Country	:	US
Telephone Number	:	702-802-1368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	09/13/2019

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Directions to “ JAZMIN O'BANNON ” Practice Location

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