Provider Demographics
NPI:1750683876
Name:JACKSON, OCEAN CHALIZA
Entity Type:Individual
Prefix:
First Name:OCEAN
Middle Name:CHALIZA
Last Name:JACKSON
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 1:5067 MADRE MESA DR
Mailing Address - Street 2:UNIT 2057
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3535
Mailing Address - Country:US
Mailing Address - Phone:424-204-3416
Mailing Address - Fax:800-783-6931
Practice Address - Street 1:5067 MADRE MESA DR
Practice Address - Street 2:UNIT 2057
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3535
Practice Address - Country:US
Practice Address - Phone:424-204-3416
Practice Address - Fax:800-783-6931
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner