Provider Demographics
NPI:1942500335
Name:JAMIS, EDELITA REMEGOSO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDELITA
Middle Name:REMEGOSO
Last Name:JAMIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15331 W BELL RD STE 212
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4104
Mailing Address - Country:US
Mailing Address - Phone:760-278-3592
Mailing Address - Fax:480-566-9632
Practice Address - Street 1:15331 W BELL RD STE 212
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4104
Practice Address - Country:US
Practice Address - Phone:760-278-3592
Practice Address - Fax:480-566-9632
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058972207R00000X
AZ58538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine