Provider Demographics
NPI:1306042023
Name:LUEVANO, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:LUEVANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 BROWN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4938
Mailing Address - Country:US
Mailing Address - Phone:707-255-1855
Mailing Address - Fax:707-255-5621
Practice Address - Street 1:2310 1ST ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2239
Practice Address - Country:US
Practice Address - Phone:707-255-1855
Practice Address - Fax:707-255-5621
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)