Provider Demographics
NPI:1568842359
Name:MALASAN, JAIME CROSLEY (RD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:CROSLEY
Last Name:MALASAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LORRENE
Other - Last Name:CROSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:567 NERO CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4130
Mailing Address - Country:US
Mailing Address - Phone:707-319-5002
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:HACIENDA BUILDING
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-372-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered