Healthcare Provider Details

I. General information

NPI: 1073446464
Provider Name (Legal Business Name): JAMIE JEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 27TH ST
SAN DIEGO CA
92154-1444
US

IV. Provider business mailing address

9182 CAMINO LAGO VIS
SPRING VALLEY CA
91977-6425
US

V. Phone/Fax

Practice location:
  • Phone: 619-575-4687
  • Fax: 619-575-1215
Mailing address:
  • Phone: 517-581-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: