Healthcare Provider Details

I. General information

NPI: 1902269160
Provider Name (Legal Business Name): JAIME MASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 BOWEN DR
FOLSOM CA
95630-7346
US

IV. Provider business mailing address

1687 BOWEN DR
FOLSOM CA
95630-7346
US

V. Phone/Fax

Practice location:
  • Phone: 916-712-2294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number303039
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA173258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: