Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS13639 | CA |
NPI | 1003062746 |
---|---|
Provider Name | Evelina Jaime |
First Address | San Diego, CA 92114-3610 |
Second Address | San Diego, CA 92114-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 13/08/2008 |