Provider Demographics
NPI:1679123749
Name:CALIMLIM, JADE NICOLE
Entity type:Individual
Prefix:MS
First Name:JADE
Middle Name:NICOLE
Last Name:CALIMLIM
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 1:7264 DANAWOODS CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7949
Mailing Address - Country:US
Mailing Address - Phone:619-813-6975
Mailing Address - Fax:
Practice Address - Street 1:6818 DORIANA ST APT 35
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-2028
Practice Address - Country:US
Practice Address - Phone:760-543-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1323884OtherDRIVER LICENSE