Provider Demographics
NPI:1568021236
Name:SAPAEN, JAIMIE RIVAS
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:RIVAS
Last Name:SAPAEN
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 1:452 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6734
Mailing Address - Country:US
Mailing Address - Phone:415-794-2533
Mailing Address - Fax:
Practice Address - Street 1:518 CASTLE ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2361
Practice Address - Country:US
Practice Address - Phone:415-794-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician