Healthcare Provider Details

I. General information

NPI: 1396322384
Provider Name (Legal Business Name): JAMIE LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N MARENGO AVE
PASADENA CA
91103-2217
US

IV. Provider business mailing address

1230 N MARENGO AVE
PASADENA CA
91103-2217
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-1124
  • Fax:
Mailing address:
  • Phone: 626-797-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPENDING
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: