Provider Demographics
NPI:1538334271
Name:D. JARDIN HEALTHCARE - DIAGNOSTICS L.P.
Entity type:Organization
Organization Name:D. JARDIN HEALTHCARE - DIAGNOSTICS L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:HERBOLARIO
Authorized Official - Last Name:BACULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:972-423-6715
Mailing Address - Street 1:PO BOX 940092
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0092
Mailing Address - Country:US
Mailing Address - Phone:972-423-6715
Mailing Address - Fax:972-578-1867
Practice Address - Street 1:1510 S AUSTIN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2404
Practice Address - Country:US
Practice Address - Phone:972-423-6715
Practice Address - Fax:972-578-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty