Provider Demographics
NPI:1548945587
Name:QUIAZON, JESSE JAMES JAIME GARCIA (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSE JAMES JAIME
Middle Name:GARCIA
Last Name:QUIAZON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 CHAMPAGNE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0310
Mailing Address - Country:US
Mailing Address - Phone:702-332-5090
Mailing Address - Fax:
Practice Address - Street 1:1551 CHAMPAGNE CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0310
Practice Address - Country:US
Practice Address - Phone:702-332-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist