Provider Demographics
NPI:1730789645
Name:JACOBSEN, LEIZEL TRINIDAD (RRT)
Entity type:Individual
Prefix:MRS
First Name:LEIZEL
Middle Name:TRINIDAD
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:LEIZEL
Other - Middle Name:
Other - Last Name:TRINIDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:2450 CHANDLER AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4059
Mailing Address - Country:US
Mailing Address - Phone:702-574-4486
Mailing Address - Fax:
Practice Address - Street 1:2450 CHANDLER AVE STE 13
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4059
Practice Address - Country:US
Practice Address - Phone:702-574-4486
Practice Address - Fax:702-476-5603
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5448172V00000X
NV2278H0200X, 3747P1801X
NVRC2320227900000X, 2279G1100X, 2279H0200X, 2279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
No2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250019853Medicaid