Provider Demographics
NPI:1740786789
Name:LAROCHELLE, MONICA B
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:B
Last Name:LAROCHELLE
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 1:7900 NW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1669
Mailing Address - Country:US
Mailing Address - Phone:305-898-1377
Mailing Address - Fax:754-222-6789
Practice Address - Street 1:7900 NW 85TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1669
Practice Address - Country:US
Practice Address - Phone:305-898-1377
Practice Address - Fax:754-222-6789
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-169343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)