Provider Demographics
NPI:1124005665
Name:ROSS, JAIME ELIZABETH-LYN (DPT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ELIZABETH-LYN
Last Name:ROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 JEREZ CT
Mailing Address - Street 2:UNIT AH
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7443
Mailing Address - Country:US
Mailing Address - Phone:213-268-3188
Mailing Address - Fax:760-630-7715
Practice Address - Street 1:510 HACIENDA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6637
Practice Address - Country:US
Practice Address - Phone:760-630-0683
Practice Address - Fax:760-630-7715
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13096Medicare ID - Type UnspecifiedGROUP