Provider Demographics
NPI:1104196120
Name:HESS, JAMIE MEILY (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MEILY
Last Name:HESS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:GROUP PROVIDER ENROLLMENT UNIT 3RD FL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:# 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3330
Practice Address - Country:US
Practice Address - Phone:951-735-6969
Practice Address - Fax:951-343-3483
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA21297363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104196120Medicaid