Provider Demographics
NPI:1831944776
Name:RODRIGUEZ ACOSTA, JEZABEL DESIREE
Entity type:Individual
Prefix:MS
First Name:JEZABEL
Middle Name:DESIREE
Last Name:RODRIGUEZ ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-9788
Mailing Address - Country:US
Mailing Address - Phone:570-710-9757
Mailing Address - Fax:
Practice Address - Street 1:321 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-9788
Practice Address - Country:US
Practice Address - Phone:570-710-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X
PAA6422434343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)