Provider Demographics
NPI:1710284989
Name:JARAMILLO, DANIEL FRED II (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:FRED
Last Name:JARAMILLO
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-1156
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:2888 EUREKA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0210
Practice Address - Country:US
Practice Address - Phone:530-243-7600
Practice Address - Fax:530-242-0808
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant