Provider Demographics
NPI:1366152472
Name:LO, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-612 HINAMOE LOOP
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1812
Mailing Address - Country:US
Mailing Address - Phone:808-375-0307
Mailing Address - Fax:
Practice Address - Street 1:45-612 HINAMOE LOOP
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-1812
Practice Address - Country:US
Practice Address - Phone:808-375-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician