JAMAL TYRONE LEDET-TRAVIS (NPI# 1194288118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194288118 |
| Entity Type | Individual |
| Full Name | JAMAL TYRONE LEDET-TRAVIS |
| Practice Address |
10201 Mission Gorge Rd Santee CA 92071-3027 |
| Mailing Address |
4746 Guymon St Rear San Diego CA 92102-3730 |
| Practice Telephone | 6193836868 |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-04-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
10201 MISSION GORGE RD |
| City | SANTEE |
| State | CA |
| Zip Code | 92071-3027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245236934 | Amber Ann Valencia-campbell | Chiropractor | 10201 Mission Gorge Rd, Ste L, Santee, CA 92071-3026 | 2005-06-27 |
| 1336758796 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 10201 Mission Gorge Rd, 2nd Floor, Suite N, Room P2, Santee, CA 92071-3027 | 2020-07-30 |
| 1265099824 | James Lee | Counselor | 10201 Mission Gorge Rd, Santee, CA 92071-3027 | 2019-05-20 |
| 1306327432 | Nicole Meehan | Registered Nurse | 10201 Mission Gorge Rd, Santee, CA 92071-3027 | 2018-08-27 |
| 1750815106 | Richard Burgess | Case Manager/Care Coordinator | 10201 Mission Gorge Rd, Santee, CA 92071-3027 | 2017-04-12 |
| 1811420078 | Joriel Jose | Case Manager/Care Coordinator | 10201 Mission Gorge Rd, Ste 0, Santee, CA 92071-3027 | 2017-04-05 |
| 1649711490 | Mental Health Systems, Inc. | Community/Behavioral Health | 10201 Mission Gorge Rd, Ste. O, C, N, Santee, CA 92071-3027 | 2017-03-13 |
| 1609314897 | Cynthia Duran | Case Manager/Care Coordinator | 10201 Mission Gorge Rd, Santee, CA 92071-3027 | 2017-02-07 |
| 1154672335 | Daniel M Kleiner, Dpm, Inc. | Podiatrist | 10201 Mission Gorge Rd, Suite K, Santee, CA 92071-3027 | 2012-09-27 |
| 1902923766 | Dr. Yang's Family Care | Family Medicine | 10201 Mission Gorge Rd, Suite H, Santee, CA 92071-3026 | 2007-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487277307 | Sjc Management and Consulting Corp | Pharmacy | 300 Lantern Crest Way Ste A, Santee, CA 92071 | 2020-05-27 |
| 1225662596 | Sharp Healthcare | Pharmacy | 8701 Cuyamaca Street, Santee, CA 92071 | 2020-02-26 |
| 1962975920 | Santee Community Pharmacy, Inc. | Pharmacy | 9836 Magnolia Ave., Santee, CA 92071 | 2019-01-02 |
| 1073095428 | Rohshana Plunkett | Dental Assistant | 9717 Mission Gorge Rd, Santee, CA 92071 | 2018-09-02 |
| 1285144071 | Victoria Koci | Behavioral Analyst | 10636 Queen Jessica Ln, Santee, CA 92071 | 2017-10-05 |
| 1699214478 | Glenn C. Ashmore Dds, Inc. | Dentist | 9480 Cuyamaca Street, San Diego, CA 92071 | 2017-02-14 |
| 1609328517 | Daniel Burciaga | Specialist/Technologist | 9915 N Magnolia Ave, Santee, CA 92071 | 2016-10-26 |
| 1861940355 | Carlos Garcia Jr. | Technician, Other | 10445 Mast Blvd # 11, Santee, CA 92071 | 2016-09-14 |
| 1962855205 | Universal Medical Solutions LLC | Durable Medical Equipment & Medical Supplies | 10020 Prospect Ave Ste A1, Santee, CA 92071 | 2016-07-22 |
| 1568871861 | Mark Adam Frens | Physical Therapist | 9236 Lapeer Ct, Santee, CA 92071 | 2014-08-12 |
| Find all providers in zip 92071 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609364363 | Michelle Green | Peer Specialist | 10201 Mission Gorge Rd Ste O, Santee, CA 92071-3040 | 2018-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477629 | Karen J Pompa | Peer Specialist | 2605 E Date Palm Paseo Apt 2194, Ontario, CA 91764-4670 | 2020-11-05 |
| 1033710231 | Marcus Kujawa | Peer Specialist | 85 Ramona Expy Ste 13, Perris, CA 92571-7014 | 2020-11-04 |
| 1962001230 | Tanya Geanna Macleod | Peer Specialist | 474 West Vermont Ave., Ste., 101, Escondido, CA 92025 | 2020-10-19 |
| 1043826753 | Dayjahnay Shantay Davenport | Peer Specialist | 3347 Lincoln Ave, San Diego, CA 92104-2111 | 2020-09-17 |
| 1497364848 | Marissa Adrianna Garza | Peer Specialist | 1502 Verona Ct, Salinas, CA 93905-2249 | 2020-07-30 |
| 1235765801 | Jill Nina Bierman | Peer Specialist | 25322 Via Piedra Roja, Laguna Niguel, CA 92677-1824 | 2020-03-16 |
| 1427683101 | Gerardo Castro | Peer Specialist | 5555 Reservoir Dr # 204-a, San Diego, CA 92120-5134 | 2020-03-03 |
| 1437783180 | Samuel Guadron Rosales | Peer Specialist | 658 E Brier Dr Ste 250, San Bernardino, CA 92408-2875 | 2020-03-02 |
| 1356973234 | Salina Sheoli Romero | Peer Specialist | 40 West G Street Ste. B, Los Banos, CA 93635 | 2020-02-07 |
| 1578103313 | Charles Winfield Eproson Jr. | Peer Specialist | 4545 Georgetown Pl Ste D, Stockton, CA 95207-6229 | 2020-01-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.