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General NPI Number Information
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NPI Number | 1255976403
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Entity Type | Organization
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Legal Business Name | BJD INC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 1025 W 24TH ST STE 26
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City | YUMA
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State | AZ
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Zip | 85364-8372
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Country | US
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Telephone | 928-318-6910
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Fax | 928-328-1056
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Provider Business Mailing Address
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Address Line | 1025 W 24TH ST STE 26
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City | YUMA
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State | AZ
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Zip | 85364-8372
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Country | US
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Telephone | 928-318-6910
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Fax | 928-328-1056
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIVYR DERAKHSHAN
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Credential |
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Telephone | 928-483-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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