Provider Demographics
NPI:1497458061
Name:GILES, JAMIE (LVN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:DENISE
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:2186 LARCHMONT ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2668
Mailing Address - Country:US
Mailing Address - Phone:909-632-8230
Mailing Address - Fax:
Practice Address - Street 1:1086 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2492
Practice Address - Country:US
Practice Address - Phone:909-305-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160004164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse