Healthcare Provider Details

I. General information

NPI: 1346321197
Provider Name (Legal Business Name): JAIME ELIEZER GIRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN ST
SOLEDAD CA
93960-2533
US

IV. Provider business mailing address

600 MAIN ST
SOLEDAD CA
93960-2533
US

V. Phone/Fax

Practice location:
  • Phone: 831-678-2665
  • Fax: 831-678-1539
Mailing address:
  • Phone: 831-678-2665
  • Fax: 831-678-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA80671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: