Healthcare Provider Details

I. General information

NPI: 1609806900
Provider Name (Legal Business Name): JONI ROCHELLE PARKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

IV. Provider business mailing address

830 KUHN DR # 211333
CHULA VISTA CA
91914-3514
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1441
  • Fax:
Mailing address:
  • Phone: 619-410-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG81690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG81690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: