Healthcare Provider Details

I. General information

NPI: 1205169570
Provider Name (Legal Business Name): JAMIE RO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39650 LIBERTY ST. STE #300, FL3
FREMONT CA
94538-2227
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOR
MOUNATIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 510-498-2689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: