1053546085 NPI number — MRS. JIZELLE VICENTA MALIA YATES RICE MSLTPRAC (SLP) CCC-S

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053546085 NPI number — MRS. JIZELLE VICENTA MALIA YATES RICE MSLTPRAC (SLP) CCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICE
Provider First Name:
JIZELLE
Provider Middle Name:
VICENTA MALIA YATES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSLTPRAC (SLP) CCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YATES
Provider Other First Name:
JIZELLE
Provider Other Middle Name:
V.M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053546085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPTAIN COOK
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-987-2451
Provider Business Mailing Address Fax Number:
855-746-1544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81-6587 MAMALAHOA HWY.
Provider Second Line Business Practice Location Address:
SUITE C-203
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-987-2451
Provider Business Practice Location Address Fax Number:
855-746-1544
Provider Enumeration Date:
05/19/2009

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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