Provider Demographics
NPI:1043022668
Name:JARAMILLO, DAVID JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JARAMILLO
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 1:810 ROLLING HILL DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-7437
Mailing Address - Country:US
Mailing Address - Phone:979-618-1717
Mailing Address - Fax:
Practice Address - Street 1:810 ROLLING HILL DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-7437
Practice Address - Country:US
Practice Address - Phone:979-618-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide