Provider Demographics
NPI:1720218662
Name:ST. CYR, JAMAL LEO (BA)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:LEO
Last Name:ST. CYR
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:JAMAL
Other - Middle Name:LEO
Other - Last Name:ST. CYR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:7155 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1130
Mailing Address - Country:US
Mailing Address - Phone:858-300-0460
Mailing Address - Fax:858-300-0461
Practice Address - Street 1:7155 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1130
Practice Address - Country:US
Practice Address - Phone:858-300-0460
Practice Address - Fax:858-300-0461
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator