Basic Information
| Provider Information | |||||||||
| NPI: | 1013929900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JARAICIE | ||||||||
| FirstName: | ELIAS | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 16950 VIA TAZON | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921271607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992777 | ||||||||
| FaxNumber: | 8585212001 | ||||||||
| Practice Location | |||||||||
| Address1: | 16950 VIA TAZON | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921271607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992777 | ||||||||
| FaxNumber: | 8585212001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A80943 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | A80943 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A809430 | 05 | CA | MEDICAID |