Provider Demographics
NPI:1245791219
Name:HEBERT, DAIJZA CACHE
Entity Type:Individual
Prefix:
First Name:DAIJZA
Middle Name:CACHE
Last Name:HEBERT
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 1:1905 W HUMBLE ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-4338
Mailing Address - Country:US
Mailing Address - Phone:281-301-9611
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3927
Practice Address - Country:US
Practice Address - Phone:281-301-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A