Provider Demographics
NPI:1922814961
Name:MEYERS, JEREMIE MICHAEL
Entity type:Individual
Prefix:
First Name:JEREMIE
Middle Name:MICHAEL
Last Name:MEYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10792 SCRIPPS RANCH BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6010
Mailing Address - Country:US
Mailing Address - Phone:619-310-3633
Mailing Address - Fax:
Practice Address - Street 1:4181 RUFFIN RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1876
Practice Address - Country:US
Practice Address - Phone:619-310-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker