Provider Demographics
NPI:1457605446
Name:HARE, JAIMEE RIZA B (NP)
Entity Type:Individual
Prefix:MRS
First Name:JAIMEE RIZA
Middle Name:B
Last Name:HARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 CAPRICORN WAY APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1892
Mailing Address - Country:US
Mailing Address - Phone:312-560-0353
Mailing Address - Fax:
Practice Address - Street 1:8382 CAPRICORN WAY APT 9
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1892
Practice Address - Country:US
Practice Address - Phone:312-560-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA729078163W00000X
CA21925363LA2200X
CA3792364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist