Healthcare Provider Details

I. General information

NPI: 1457605446
Provider Name (Legal Business Name): JAIMEE RIZA B HARE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8382 CAPRICORN WAY APT 9
SAN DIEGO CA
92126-1892
US

IV. Provider business mailing address

8382 CAPRICORN WAY APT 9
SAN DIEGO CA
92126-1892
US

V. Phone/Fax

Practice location:
  • Phone: 312-560-0353
  • Fax:
Mailing address:
  • Phone: 312-560-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3792
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number729078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: