Provider Demographics
NPI:1700539319
Name:ALLEN-GEORGE, JAKIYE DAESHAUN
Entity Type:Individual
Prefix:
First Name:JAKIYE
Middle Name:DAESHAUN
Last Name:ALLEN-GEORGE
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 1:7105 SOLANA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2537
Mailing Address - Country:US
Mailing Address - Phone:725-724-6276
Mailing Address - Fax:
Practice Address - Street 1:1775 E TROPICANA AVE STE 16B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6557
Practice Address - Country:US
Practice Address - Phone:702-405-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant