=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144534108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAIME M. SINGZON, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2010
-----------------------------------------------------
Last Update Date | 01/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 646 TENNESSEE ST
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-554-3331
-----------------------------------------------------
Fax | 707-554-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 632
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-0063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-554-3331
-----------------------------------------------------
Fax | 707-554-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO, SECRETARY
-----------------------------------------------------
Name | MRS. ELIZABETH ANN SINGZON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-554-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A41529
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------