Provider Demographics
NPI:1821447095
Name:KUYKENDALL-JABARI, RHONDA
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:KUYKENDALL-JABARI
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 1:8703 LA TIJERA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3900
Mailing Address - Country:US
Mailing Address - Phone:323-454-1124
Mailing Address - Fax:
Practice Address - Street 1:8703 LA TIJERA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3900
Practice Address - Country:US
Practice Address - Phone:323-454-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist