Healthcare Provider Details

I. General information

NPI: 1205734035
Provider Name (Legal Business Name): JAMEY KING CWC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2026
Last Update Date: 10/30/2026
Certification Date: 10/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 EUREKA CANYON RD
CORRALITOS CA
95076-0151
US

IV. Provider business mailing address

1245 EUREKA CANYON RD
CORRALITOS CA
95076-0151
US

V. Phone/Fax

Practice location:
  • Phone: 831-531-7487
  • Fax:
Mailing address:
  • Phone: 831-531-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3E2116A02E
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: