Healthcare Provider Details

I. General information

NPI: 1992382063
Provider Name (Legal Business Name): JARED ANTRANIG AVAKIAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 JEFFERSON ST
NAPA CA
94559-1732
US

IV. Provider business mailing address

1734 JEFFERSON ST
NAPA CA
94559-1732
US

V. Phone/Fax

Practice location:
  • Phone: 797-224-2283
  • Fax:
Mailing address:
  • Phone: 797-224-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number35045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: