Provider Demographics
NPI:1205685765
Name:JAIMES, MARIA (RDAEF2)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:JAIMES
Suffix:
Gender:F
Credentials:RDAEF2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13390 LARKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3205
Mailing Address - Country:US
Mailing Address - Phone:951-250-8121
Mailing Address - Fax:
Practice Address - Street 1:79800 HIGHWAY 111 STE 109
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6003
Practice Address - Country:US
Practice Address - Phone:951-250-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA62866126800000X
CAAEF1330126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant