Provider Demographics
NPI:1912056177
Name:DAVID, JAIME CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:CRISTOBAL
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20009 SHOSHONEE RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5590
Mailing Address - Country:US
Mailing Address - Phone:760-946-3381
Mailing Address - Fax:
Practice Address - Street 1:18419 OUTER HIGHWAY 18
Practice Address - Street 2:SUITE #6
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-1967
Practice Address - Fax:760-242-3438
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95834207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice