Provider Demographics
NPI:1245060474
Name:GOBERT, RIDASHA (RN)
Entity type:Individual
Prefix:
First Name:RIDASHA
Middle Name:
Last Name:GOBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RIDASHA
Other - Middle Name:
Other - Last Name:HAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-3107
Mailing Address - Country:US
Mailing Address - Phone:409-920-5190
Mailing Address - Fax:
Practice Address - Street 1:1818 24TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-3107
Practice Address - Country:US
Practice Address - Phone:409-920-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX855964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse