Healthcare Provider Details

I. General information

NPI: 1013539634
Provider Name (Legal Business Name): JAMES WILLIAM JEFFRIES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD STE 201
REDLANDS CA
92373-4881
US

IV. Provider business mailing address

255 TERRACINA BLVD STE 201
REDLANDS CA
92373-4881
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2500
  • Fax:
Mailing address:
  • Phone: 909-792-8500
  • Fax: 909-793-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: