Healthcare Provider Details

I. General information

NPI: 1346425253
Provider Name (Legal Business Name): MR. JAIME OCADIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 CENTRE ST STE 101
SAN DIEGO CA
92103-2655
US

IV. Provider business mailing address

4080 CENTRE ST STE 101
SAN DIEGO CA
92103-2655
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-9850
  • Fax:
Mailing address:
  • Phone: 619-543-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: