1710794938 NPI number — RYLEE JEAN JOBE PA STUDENT

Table of content: MERIALDA TAHIRAGA R.D.H. (NPI 1154739720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710794938 NPI number — RYLEE JEAN JOBE PA STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOBE
Provider First Name:
RYLEE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA STUDENT
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:
1710794938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13307 BILTMORE LKS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVE OAK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78233-5449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-414-0657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 FISHER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39534-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-376-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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