MEDICARE: JAYCEE JAMES NON PHYSICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	175L00000X	Homeopath
2	175F00000X	Naturopath
3	171M00000X	Case Manager/Care Coordinator
4	251B00000X	Case Management Agency
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568860823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYCEE JAMES NON PHYSICIAN

Provider Business Mailing Address
First Line	:	17531 HUDSON DRIVE
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92395
Country	:	US
Telephone Number	:	760-596-4517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2029 CENTURY PARK E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067
Country	:	US
Telephone Number	:	760-205-9006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	01/23/2015

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