Provider Demographics
NPI:1255956918
Name:JAIME, MATTHEW JOHN (RD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOHN
Last Name:JAIME
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W BELFORD RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9777
Mailing Address - Country:US
Mailing Address - Phone:760-791-7654
Mailing Address - Fax:
Practice Address - Street 1:515 W BELFORD RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9777
Practice Address - Country:US
Practice Address - Phone:760-791-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered