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General NPI Number Information
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NPI Number | 1538334271
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Entity Type | Organization
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Legal Business Name | D. JARDIN HEALTHCARE - DIAGNOSTICS L.P.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1510 S AUSTIN ST
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City | AMARILLO
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State | TX
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Zip | 79102-2404
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Country | US
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Telephone | 972-423-6715
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Fax | 972-578-1867
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Provider Business Mailing Address
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Address Line | PO BOX 940092
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City | PLANO
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State | TX
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Zip | 75094-0092
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Country | US
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Telephone | 972-423-6715
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Fax | 972-578-1867
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDI HERBOLARIO BACULI
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Credential | M.D,
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Telephone | 972-423-6715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L2117
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License Number State | TX
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