Provider Demographics
NPI:1629383088
Name:ROSE, JAMI RENEE (LAC DIPL OM)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:RENEE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GARNET AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2834
Mailing Address - Country:US
Mailing Address - Phone:619-356-1665
Mailing Address - Fax:
Practice Address - Street 1:1001 GARNET AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2834
Practice Address - Country:US
Practice Address - Phone:619-356-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13048171100000X
ORAC152387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist