Provider Demographics
NPI:1093126609
Name:COLIN X JAIRAM MD INC
Entity Type:Organization
Organization Name:COLIN X JAIRAM MD INC
Other - Org Name:HYBRID MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:XEPHARY
Authorized Official - Last Name:JAIRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-429-1919
Mailing Address - Street 1:1031 AVENIDA PICO
Mailing Address - Street 2:SUTIE 103
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6352
Mailing Address - Country:US
Mailing Address - Phone:949-429-1919
Mailing Address - Fax:
Practice Address - Street 1:1031 AVENIDA PICO
Practice Address - Street 2:SUTIE 103
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6352
Practice Address - Country:US
Practice Address - Phone:202-904-8490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH749ZMedicare UPIN