Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | L6437 | TX |
NPI | 1265512529 |
---|---|
Provider Name | Jill Jaimes |
First Address | Houston, TX 77030-2303 |
Second Address | Houston, TX 77030-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159594401 | (05) | TX |
H90636 | (02) |