Provider Demographics
NPI:1891490389
Name:JACKSON, ALEXIS ESPINOZA
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:ESPINOZA
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 1:1650 JUNIPER TWIG AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7117
Mailing Address - Country:US
Mailing Address - Phone:702-817-1070
Mailing Address - Fax:
Practice Address - Street 1:7260 W. AZURE DRIVE
Practice Address - Street 2:STE 140-44
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4413
Practice Address - Country:US
Practice Address - Phone:702-789-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician