Provider Demographics
NPI:1326709627
Name:JAIME-LY, BEA ZERGIELLANE DAVID
Entity type:Individual
Prefix:
First Name:BEA ZERGIELLANE
Middle Name:DAVID
Last Name:JAIME-LY
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 1:14619 LA FONDA DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4021
Mailing Address - Country:US
Mailing Address - Phone:714-624-6401
Mailing Address - Fax:
Practice Address - Street 1:7765 LEEDS ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3489
Practice Address - Country:US
Practice Address - Phone:858-336-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95071652163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health