Provider Demographics
NPI:1386238541
Name:JARAMILLO, GERALDINE SORELLY
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:SORELLY
Last Name:JARAMILLO
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 1:215 MARVIN ELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8983
Mailing Address - Country:US
Mailing Address - Phone:786-868-7559
Mailing Address - Fax:
Practice Address - Street 1:215 MARVIN ELWOOD RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8983
Practice Address - Country:US
Practice Address - Phone:786-868-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist