Provider Demographics
NPI:1588001499
Name:JEFFERSON-DAS, ANGELINA REGINA
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:REGINA
Last Name:JEFFERSON-DAS
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 1:7918 VILLA PINTURA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1681
Mailing Address - Country:US
Mailing Address - Phone:702-239-8633
Mailing Address - Fax:
Practice Address - Street 1:5715 W ALEXANDER RD STE 155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2807
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst