MEDICARE: JAMIE ESPRECION

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	172A00000X	Driver		NV

General Provider Information

NPI Number	:	1558924134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ESPRECION

Provider Business Mailing Address
First Line	:	6210 N JONES BLVD UNIT 753611
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89136-8964
Country	:	US
Telephone Number	:	702-970-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 EXTRAVAGANT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	702-970-7440
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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