MEDICARE: ELISA M JAIME

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	373H00000X	Day Training/Habilitation Specialist		CA
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1760107486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA M JAIME

Provider Business Mailing Address
First Line	:	202 N 8TH ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2302
Country	:	US
Telephone Number	:	442-265-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 N 8TH ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2302
Country	:	US
Telephone Number	:	442-265-1525
Fax Number	:

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

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	05/27/2026

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Directions to “ ELISA M JAIME ” Practice Location

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