Healthcare Provider Details

I. General information

NPI: 1043135825
Provider Name (Legal Business Name): JENNIFER C JAIME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 SAN DIEGO AVE
SAN DIEGO CA
92110-1906
US

IV. Provider business mailing address

3767 1/2 4TH AVE
SAN DIEGO CA
92103-4202
US

V. Phone/Fax

Practice location:
  • Phone: 619-340-0082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR1485030922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: