Healthcare Provider Details

I. General information

NPI: 1538452396
Provider Name (Legal Business Name): ROCHELLE JACINTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 FRANKFORD AVENUE 2ND FLOOR
LUBBOCK TX
79424
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0267
  • Fax: 806-761-0268
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ0653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: