Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME112300 | FL |
NPI | 1003150103 |
---|---|
Provider Name | Diana Jaime |
First Address | Orlando, FL 32814-6606 |
Second Address | Orlando, FL 32814-6606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 22/12/2013 |