1285830505 NPI number — DR. KAREN HERBST JAMISON M.D.

Table of content: MRS. MELANIE L AMEZCUA LMP (NPI 1174806194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285830505 NPI number — DR. KAREN HERBST JAMISON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMISON
Provider First Name:
KAREN
Provider Middle Name:
HERBST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERBST
Provider Other First Name:
KAREN
Provider Other Middle Name:
ALIDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285830505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4060 FOURTH AVE
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-298-1318
Provider Business Mailing Address Fax Number:
619-298-0843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4060 FOURTH AVE
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-298-1318
Provider Business Practice Location Address Fax Number:
619-298-0843
Provider Enumeration Date:
06/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A95356 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A953560 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912003252 . This is a "HILLCREST INTERNAL MEDICINE GROUP NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WA95356A . This is a "MEDICARE PIN LINKED WITH SD HOSPITAL BASED PHYSICIANS MED ASSN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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