Provider Demographics
NPI:1760922975
Name:JACOBRA LLC
Entity Type:Organization
Organization Name:JACOBRA LLC
Other - Org Name:LICE CLINICS OF AMERICA - NOVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRAMBOISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-303-1576
Mailing Address - Street 1:455 CARLISLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5621
Mailing Address - Country:US
Mailing Address - Phone:703-303-1576
Mailing Address - Fax:
Practice Address - Street 1:455 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5621
Practice Address - Country:US
Practice Address - Phone:703-303-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty