Provider Demographics
NPI:1194248377
Name:SHOEMAKER, JAMIE DIANE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DIANE
Last Name:SHOEMAKER
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 1:8313 WESTLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2824
Mailing Address - Country:US
Mailing Address - Phone:310-994-4482
Mailing Address - Fax:
Practice Address - Street 1:8313 WESTLAWN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2824
Practice Address - Country:US
Practice Address - Phone:310-994-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)