Provider Demographics
NPI:1366680779
Name:JAIME, LUCY CLEOPHAS (SIVANI JAIME)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:CLEOPHAS
Last Name:JAIME
Suffix:
Gender:F
Credentials:SIVANI JAIME
Other - Prefix:
Other - First Name:SIVANI
Other - Middle Name:LUCY
Other - Last Name:JAIME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SIVANI JAIME LAC
Mailing Address - Street 1:1132 CALLAS LN
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2428
Mailing Address - Country:US
Mailing Address - Phone:831-588-8169
Mailing Address - Fax:
Practice Address - Street 1:375 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4601
Practice Address - Country:US
Practice Address - Phone:831-588-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11656171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist