Individual
MS. JAIME LEE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 E DAKOTA AVE, FRESNO, CA 93726-4804
(559) 453-4405
(559) 453-5111
Mailing address
2085 E DAKOTA AVE, FRESNO, CA 93726-4804
(559) 453-4405
(559) 453-5111
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251B00000X
—
CA
Enumeration date
06/09/2009
Last updated
06/09/2009
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