1679826606 NPI number — DR. JESSICA LITTIER DURSO D.C.

Table of content: DR. JESSICA LITTIER DURSO D.C. (NPI 1679826606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679826606 NPI number — DR. JESSICA LITTIER DURSO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURSO
Provider First Name:
JESSICA
Provider Middle Name:
LITTIER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LITTIER
Provider Other First Name:
JESSICA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679826606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6730 MONTEZUMA CASTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89084-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-608-3362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6462 LOSEE RD
Provider Second Line Business Practice Location Address:
STE 135
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89086-0104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-608-3362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  B01476 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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