Healthcare Provider Details

I. General information

NPI: 1659221265
Provider Name (Legal Business Name): JAIME MIRAMONTES PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 WINTER HAVEN RD
FALLBROOK CA
92028-4500
US

IV. Provider business mailing address

1056 WINTER HAVEN RD
FALLBROOK CA
92028-4500
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-6395
  • Fax: 760-723-6392
Mailing address:
  • Phone: 760-723-6395
  • Fax: 760-723-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number210161238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: