Provider Demographics
NPI:1487224937
Name:LUZADER, JAMIE MARIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:LUZADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8755 MESA RD APT 12
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3644
Mailing Address - Country:US
Mailing Address - Phone:805-689-8441
Mailing Address - Fax:
Practice Address - Street 1:1120 PEPPER DR SPC 84
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-1323
Practice Address - Country:US
Practice Address - Phone:619-995-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider