Provider Demographics
NPI:1558013391
Name:LLARENA, JAMIE AILED JANE DIZON (RN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE AILED JANE
Middle Name:DIZON
Last Name:LLARENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N HUNTINGTON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7404
Mailing Address - Country:US
Mailing Address - Phone:516-289-1162
Mailing Address - Fax:
Practice Address - Street 1:211 N HUNTINGTON AVE APT 8
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7404
Practice Address - Country:US
Practice Address - Phone:516-289-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65135801-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse