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General NPI Number Information
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NPI Number | 1457655938
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Entity Type | Individual
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Provider Name | JAMIE LYNN BOOTH PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 27300 IRIS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4802
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Country | US
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Telephone | 951-243-2018
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Fax |
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Provider Business Mailing Address
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Address Line | 42126 SWEETSHADE LN
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City | TEMECULA
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State | CA
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Zip | 92591-3821
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Country | US
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Telephone | 909-210-3059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21124
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License Number State | CA
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