Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1548 | AZ |
Y | 213ES0000X | Sports Medicine | 1548 | AZ |
NPI | 1093235772 |
---|---|
Provider Name | Jazmine Cynice Roland |
First Address | Cottonwood, AZ 86326-7003 |
Second Address | Cottonwood, AZ 86326-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 22/06/2017 |