Healthcare Provider Details

I. General information

NPI: 1962354373
Provider Name (Legal Business Name): MR. JAIME TARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD
MODESTO CA
95351-1153
US

IV. Provider business mailing address

1620 N CARPENTER RD STE D41
MODESTO CA
95351-1160
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-3710
  • Fax:
Mailing address:
  • Phone: 209-523-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: