Provider Demographics
NPI:1306310982
Name:JAIME, MONICA (HAD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JAIME
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8263 GROVE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3107
Mailing Address - Country:US
Mailing Address - Phone:909-920-9906
Mailing Address - Fax:909-920-4151
Practice Address - Street 1:8263 GROVE AVE STE 203
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3107
Practice Address - Country:US
Practice Address - Phone:909-920-9906
Practice Address - Fax:909-920-4151
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8442237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164559456Medicaid