Healthcare Provider Details

I. General information

NPI: 1255266888
Provider Name (Legal Business Name): DAJA AMBERNIQUE COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 NORTH BLVD
BATON ROUGE LA
70806-3914
US

IV. Provider business mailing address

150 EVANGELINE DR
DONALDSONVILLE LA
70346-4325
US

V. Phone/Fax

Practice location:
  • Phone: 225-963-1830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB932942
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: