Provider Demographics
NPI:1740699156
Name:FOX, JAMIE
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:FOX
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 1:3841 BRICKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8226
Mailing Address - Country:US
Mailing Address - Phone:707-569-2451
Mailing Address - Fax:
Practice Address - Street 1:3841 BRICKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8226
Practice Address - Country:US
Practice Address - Phone:707-569-2451
Practice Address - Fax:707-659-2323
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program