Provider Demographics
NPI:1801819537
Name:CHANLATTE-GARCIA, JACQUELINE O (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:O
Last Name:CHANLATTE-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 ARBOR ST STE 144
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2072
Mailing Address - Country:US
Mailing Address - Phone:402-588-0678
Mailing Address - Fax:531-466-2091
Practice Address - Street 1:9015 ARBOR ST STE 144
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2072
Practice Address - Country:US
Practice Address - Phone:402-588-0678
Practice Address - Fax:531-466-2091
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19943207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024986800Medicaid
NE10024986800Medicaid
NEG19533Medicare UPIN