Individual
DR. JAIME AYUSO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, EMT
Contact information
Practice address
2501 W 84TH ST, BLOOMINGTON, MN 55431-1602
(952) 214-1176
Mailing address
967 FERNDALE ST S, MAPLEWOOD, MN 55119-5946
(407) 810-6094
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407471642
—
MN
Enumeration date
06/13/2020
Last updated
10/31/2023
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