Provider Demographics
NPI:1306255542
Name:JACKSON-WILLIAMS, MARIA AGATHA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AGATHA
Last Name:JACKSON-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:AGATHA
Other - Last Name:SEDZRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2580 N RANCHO DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3361
Mailing Address - Country:US
Mailing Address - Phone:951-400-8548
Mailing Address - Fax:
Practice Address - Street 1:2580 N RANCHO DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3361
Practice Address - Country:US
Practice Address - Phone:951-400-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner