Provider Demographics
NPI:1295147544
Name:NORMAN, JAYNEL
Entity type:Individual
Prefix:
First Name:JAYNEL
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:CABAZON
Mailing Address - State:CA
Mailing Address - Zip Code:92230-0413
Mailing Address - Country:US
Mailing Address - Phone:951-849-2853
Mailing Address - Fax:
Practice Address - Street 1:14520 MISSION ST.
Practice Address - Street 2:
Practice Address - City:CABAZON
Practice Address - State:CA
Practice Address - Zip Code:92230
Practice Address - Country:US
Practice Address - Phone:951-849-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281656164X00000X
3747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide