MEDICARE: DR. JESSE JAMES JAIME GARCIA QUIAZON DPT

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	225100000X	Physical Therapist	4646	NV

General Provider Information

NPI Number	:	1548945587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE JAMES JAIME GARCIA QUIAZON DPT

Provider Business Mailing Address
First Line	:	1551 CHAMPAGNE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0310
Country	:	US
Telephone Number	:	702-332-5090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 CHAMPAGNE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0310
Country	:	US
Telephone Number	:	702-332-5090
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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