Provider Demographics
NPI:1598034431
Name:DIXON, JAMILAH SAGIRAH (CADS)
Entity Type:Individual
Prefix:
First Name:JAMILAH
Middle Name:SAGIRAH
Last Name:DIXON
Suffix:
Gender:F
Credentials:CADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0520
Mailing Address - Country:US
Mailing Address - Phone:505-920-9233
Mailing Address - Fax:505-852-1827
Practice Address - Street 1:612 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2963
Practice Address - Country:US
Practice Address - Phone:505-920-9233
Practice Address - Fax:505-852-1827
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist