Provider Demographics
NPI:1356526263
Name:JAIME C DAVID MD INC
Entity type:Organization
Organization Name:JAIME C DAVID MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-1967
Mailing Address - Street 1:18419 US HIGHWAY 18 STE 6
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2333
Mailing Address - Country:US
Mailing Address - Phone:760-242-1967
Mailing Address - Fax:
Practice Address - Street 1:18419 US HIGHWAY 18 STE 6
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2333
Practice Address - Country:US
Practice Address - Phone:760-242-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495834261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care