Provider Demographics
NPI:1265947824
Name:JABOUIN, KRISTOPHER MARCUS
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MARCUS
Last Name:JABOUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 NW 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1407
Mailing Address - Country:US
Mailing Address - Phone:954-531-4707
Mailing Address - Fax:
Practice Address - Street 1:7675 NW 20TH CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3901
Practice Address - Country:US
Practice Address - Phone:954-531-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other