Provider Demographics
NPI:1659569069
Name:JAIMES, ROCIO
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:JAIMES
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 1:8210 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2901
Mailing Address - Country:US
Mailing Address - Phone:718-236-4037
Mailing Address - Fax:718-236-4085
Practice Address - Street 1:8210 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2901
Practice Address - Country:US
Practice Address - Phone:718-236-4037
Practice Address - Fax:718-236-4085
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP59068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist