1376343806 NPI number — MS. ATAVIA ROCHILLE HICKMAN RADT

Table of content: MS. ATAVIA ROCHILLE HICKMAN RADT (NPI 1376343806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376343806 NPI number — MS. ATAVIA ROCHILLE HICKMAN RADT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKMAN
Provider First Name:
ATAVIA
Provider Middle Name:
ROCHILLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RADT
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:
1376343806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7121 COLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90242-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-241-1577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20302 FLANAGAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRABUCO CANYON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-582-8836
Provider Business Practice Location Address Fax Number:
818-582-8836
Provider Enumeration Date:
03/14/2025

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: 101YA0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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