Healthcare Provider Details

I. General information

NPI: 1558013391
Provider Name (Legal Business Name): JAMIE AILED JANE DIZON LLARENA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N HUNTINGTON AVE APT 8
MONTEREY PARK CA
91754-7404
US

IV. Provider business mailing address

211 N HUNTINGTON AVE APT 8
MONTEREY PARK CA
91754-7404
US

V. Phone/Fax

Practice location:
  • Phone: 516-289-1162
  • Fax:
Mailing address:
  • Phone: 516-289-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number65135801-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: