Provider Demographics
NPI:1396393104
Name:PERKINS, ROZINA MARIE
Entity Type:Individual
Prefix:
First Name:ROZINA
Middle Name:MARIE
Last Name:PERKINS
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 1:2814 S MEADOWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4737
Mailing Address - Country:US
Mailing Address - Phone:225-936-1166
Mailing Address - Fax:
Practice Address - Street 1:2814 S MEADOWOOD AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4737
Practice Address - Country:US
Practice Address - Phone:225-936-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000000Medicaid