Healthcare Provider Details

I. General information

NPI: 1083557078
Provider Name (Legal Business Name): JAMIE LYNN SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 MISSION GORGE RD
SANTEE CA
92071-3857
US

IV. Provider business mailing address

10159 MISSION GORGE RD
SANTEE CA
92071-3857
US

V. Phone/Fax

Practice location:
  • Phone: 619-449-0881
  • Fax: 619-449-0881
Mailing address:
  • Phone: 619-449-0881
  • Fax: 619-449-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRTT1418430126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: