Healthcare Provider Details

I. General information

NPI: 1265166250
Provider Name (Legal Business Name): DEYANAH JARRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 12/26/2022
Reactivation Date: 07/17/2023

III. Provider practice location address

41185 GOLDEN GATE CIR STE 108
MURRIETA CA
92562-6995
US

IV. Provider business mailing address

35653 RUTH AVE
WILDOMAR CA
92595-9003
US

V. Phone/Fax

Practice location:
  • Phone: 951-579-8525
  • Fax:
Mailing address:
  • Phone: 951-579-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: