Healthcare Provider Details

I. General information

NPI: 1700869005
Provider Name (Legal Business Name): JARED SCOTT CAMPBELL RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE E421
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

2875 N LOS FELICES RD APT 204
PALM SPRINGS CA
92262-1979
US

V. Phone/Fax

Practice location:
  • Phone: 760-534-5954
  • Fax:
Mailing address:
  • Phone: 760-534-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number951340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: