Individual provider Active NPI

Jetaime Covello

  • Registered Nurse
  • Chula Vista, CA
National Provider Identifier
1396449005
Registry record updated Apr 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
95227185 Issued in CA
Practice address
330 Moss St
Chula Vista, CA 91911-2005
Phone
(619) 426-6310
NPI assigned
Mar 28, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95227185 CA Primary

Addresses

Primary practice location

330 Moss St
Chula Vista, CA 91911-2005

Mailing address

4114 Florida St
San Diego, CA 92104-1009
Phone (312) 576-0035

Other practice location 1

4309 3rd Ave
San Diego, CA 92103-1407
Phone (619) 876-4502

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
95227185CAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680307200000",
    "number": "1396449005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 FLORIDA ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921041009",
            "telephone_number": "312-576-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MOSS ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919112005",
            "telephone_number": "619-426-6310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4309 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921031407",
            "country_code": "US",
            "telephone_number": "619-876-4502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COVELLO",
        "first_name": "JETAIME",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-04-01",
        "certification_date": "2023-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95227185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.