Provider Demographics
NPI:1306839121
Name:JAIMES, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JAIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CHESTNUT AVE
Mailing Address - Street 2:ROOM 205
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2944
Mailing Address - Country:US
Mailing Address - Phone:562-599-8635
Mailing Address - Fax:562-218-0853
Practice Address - Street 1:1333 CHESTNUT AVE
Practice Address - Street 2:ROOM 205
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2944
Practice Address - Country:US
Practice Address - Phone:562-599-8635
Practice Address - Fax:562-218-0853
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27993Medicare UPIN