1912456732 NPI number — MRS. JAMIE BAHA MA, LAC

Table of content: MRS. JAMIE BAHA MA, LAC (NPI 1912456732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912456732 NPI number — MRS. JAMIE BAHA MA, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAHA
Provider First Name:
JAMIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGHEY
Provider Other First Name:
JAMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912456732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 WEST PONDEROSA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE RIVER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-338-4858
Provider Business Mailing Address Fax Number:
928-338-4100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 WEST PONDEROSA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE RIVER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-338-4858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2016

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: 101YP2500X , with the licence number:  15560 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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