Healthcare Provider Details

I. General information

NPI: 1952877375
Provider Name (Legal Business Name): MANUEL JAIMES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 S 14TH ST
SAN JOSE CA
95112-2015
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-3293
  • Fax:
Mailing address:
  • Phone: 408-842-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: