Provider Demographics
NPI:1588385439
Name:CABEZUELA, JAIME JESUS JR
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:JESUS
Last Name:CABEZUELA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E 22ND ST APT 528
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6945
Mailing Address - Country:US
Mailing Address - Phone:619-731-1568
Mailing Address - Fax:
Practice Address - Street 1:708 E 22ND ST APT 528
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6945
Practice Address - Country:US
Practice Address - Phone:619-731-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst