MEDICARE: DR. JAIME O HENRIQUEZ MD

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	207RC0000X	Cardiovascular Disease Physician	A79202	CA
2	207RI0011X	Interventional Cardiology Physician	A79202	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922058718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME O HENRIQUEZ MD

Provider Business Mailing Address
First Line	:	235 E BADILLO ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2116
Country	:	US
Telephone Number	:	626-793-2885
Fax Number	:	626-793-6262

Provider Business Practice Location Address
First Line	:	289 W HUNTINGTON DR STE 401
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-3493
Country	:	US
Telephone Number	:	626-254-0074
Fax Number	:	626-254-0079

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/19/2025

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Directions to “ DR. JAIME O HENRIQUEZ MD” Practice Location

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