Basic Information
| Provider Information | |||||||||
| NPI: | 1023550464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JARAMILLO-MORA | ||||||||
| FirstName: | JASMELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 HAILEYS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | LILESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280917099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863933941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1018 N BRAGG BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283903316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102952609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT1745161 | FL | N | 106S00000X | RBT1745161 | NC | N | 106E00000X | 02111848 | NC | Y |
No ID Information.