Healthcare Provider Details

I. General information

NPI: 1932010105
Provider Name (Legal Business Name): JAYDAH ARIAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 BUCHANAN RD STE A1
ANTIOCH CA
94509-4214
US

IV. Provider business mailing address

504 NORTHBANK CT APT 15
STOCKTON CA
95207-7655
US

V. Phone/Fax

Practice location:
  • Phone: 925-215-0015
  • Fax:
Mailing address:
  • Phone: 559-769-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: