Individual
TSAE'YEH LA'SHAE JIMMERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9500 HAVEN AVE, RANCHO CUCAMONGA, CA 91730-5807
(909) 980-6700
Mailing address
25910 ACERO STE 160, MISSION VIEJO, CA 92691-2777
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-PLFAYG
CA
Other
Enumeration date
01/09/2021
Last updated
04/22/2025
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