Provider Demographics
NPI:1164928610
Name:ABDUL-JALAAL, SADIYYA MUSLIMA
Entity Type:Individual
Prefix:
First Name:SADIYYA
Middle Name:MUSLIMA
Last Name:ABDUL-JALAAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TRAIL PEAK LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-2570
Mailing Address - Country:US
Mailing Address - Phone:702-485-9174
Mailing Address - Fax:
Practice Address - Street 1:1920 TRAIL PEAK LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-2570
Practice Address - Country:US
Practice Address - Phone:702-485-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician