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General NPI Number Information
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NPI Number | 1619561107
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Entity Type | Individual
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Provider Name | ROSARIO JAIME
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Gender | Female
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 7185 NAVAJO RD STE D
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City | SAN DIEGO
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State | CA
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Zip | 92119-1648
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Country | US
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Telephone | 619-663-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 10739 OAK CREEK DR
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City | LAKESIDE
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State | CA
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Zip | 92040-1644
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Country | US
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Telephone | 858-222-7847
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SPA4399
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP34439
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License Number State | CA
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