1689981938 NPI number — ROCHELLE LOTOYA DAHL JACKSON AS

Table of content: ROCHELLE LOTOYA DAHL JACKSON AS (NPI 1689981938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689981938 NPI number — ROCHELLE LOTOYA DAHL JACKSON AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHL JACKSON
Provider First Name:
ROCHELLE
Provider Middle Name:
LOTOYA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689981938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5458 VIA DELRAY
Provider Second Line Business Mailing Address:
UNIT 201
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-1356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-713-3329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 N FLAMINGO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-846-7799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2010

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: 224Z00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com