Healthcare Provider Details

I. General information

NPI: 1659949535
Provider Name (Legal Business Name): NATASHA JILLAN CARDOZA RRT/NPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PARKWAY
WEST ROXBURY MA
02132
US

IV. Provider business mailing address

23 RACHAEL CIRCLE
SOUTH EASTON MA
02375
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6441
  • Fax:
Mailing address:
  • Phone: 857-991-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT3405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: