Healthcare Provider Details

I. General information

NPI: 1952934945
Provider Name (Legal Business Name): JARED VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 N BROADWAY
LOS ANGELES CA
90031
US

IV. Provider business mailing address

3303 N BROADWAY
LOS ANGELES CA
90031
US

V. Phone/Fax

Practice location:
  • Phone: 323-478-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: