MEDICARE: MS. JADE NICOLE CALIMLIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F1323884	OTHER	CA	DRIVER LICENSE

General Provider Information

NPI Number	:	1679123749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JADE NICOLE CALIMLIM

Provider Business Mailing Address
First Line	:	7264 DANAWOODS CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-7949
Country	:	US
Telephone Number	:	619-813-6975
Fax Number	:

Provider Business Practice Location Address
First Line	:	6818 DORIANA ST APT 35
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-2028
Country	:	US
Telephone Number	:	760-543-6509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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