Provider Demographics
NPI:1154207074
Name:NATHASON, JAYME
Entity type:Individual
Prefix:DR
First Name:JAYME
Middle Name:
Last Name:NATHASON
Suffix:
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 1:1545 HOTEL CIR S STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3414
Mailing Address - Country:US
Mailing Address - Phone:619-693-8559
Mailing Address - Fax:619-413-6303
Practice Address - Street 1:1545 HOTEL CIR S STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3414
Practice Address - Country:US
Practice Address - Phone:619-693-8559
Practice Address - Fax:619-413-6303
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist