Provider Demographics
NPI:1336764547
Name:JACINTO, JESSE CHRISTIAN MEGIA
Entity Type:Individual
Prefix:
First Name:JESSE CHRISTIAN
Middle Name:MEGIA
Last Name:JACINTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 CROSS MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-8309
Mailing Address - Country:US
Mailing Address - Phone:661-860-3022
Mailing Address - Fax:
Practice Address - Street 1:5454 CROSS MEADOWS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-8309
Practice Address - Country:US
Practice Address - Phone:661-860-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant