Provider Demographics
NPI:1376555359
Name:JAY, JAN CHERI (DOM)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:CHERI
Last Name:JAY
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11000 SPAIN RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1893
Mailing Address - Country:US
Mailing Address - Phone:505-323-8100
Mailing Address - Fax:505-292-0555
Practice Address - Street 1:11000 SPAIN RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1893
Practice Address - Country:US
Practice Address - Phone:505-323-8100
Practice Address - Fax:505-292-0555
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM637RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00RRD61OtherBLUE CROSS HEALTH PLAN