Provider Demographics
NPI:1720015795
Name:PEREZ-TSELIKIS, JACQUELINE L (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:PEREZ-TSELIKIS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10105 BANBURRY CROSS DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6646
Mailing Address - Country:US
Mailing Address - Phone:702-260-4525
Mailing Address - Fax:702-869-0133
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:SUITE 370
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-260-4525
Practice Address - Fax:702-869-0133
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV7004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019680Medicaid
NV002019680Medicaid