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General NPI Number Information
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NPI Number | 1629882956
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Entity Type | Organization
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Legal Business Name | PACIFIC KETAMINE AND WELLNESS, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 412 CEDAR ST STE C2
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City | SANTA CRUZ
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State | CA
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Zip | 95060-4369
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Country | US
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Telephone | 831-824-4003
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Fax |
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Provider Business Mailing Address
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Address Line | 412 CEDAR ST STE C2
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City | SANTA CRUZ
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State | CA
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Zip | 95060-4369
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Country | US
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Telephone | 831-824-4003
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | JAIME JIMENEZ
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Credential | PMHBC
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Telephone | 831-824-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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