Healthcare Provider Details

I. General information

NPI: 1841609096
Provider Name (Legal Business Name): MR. NELSON JAY BAJE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY
BREA CA
92821-6713
US

IV. Provider business mailing address

2295 S VINEYARD AVE
ONTARIO CA
91761-7925
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8720
  • Fax:
Mailing address:
  • Phone: 909-724-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number35549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: