Healthcare Provider Details

I. General information

NPI: 1578025854
Provider Name (Legal Business Name): JARED BUFFINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SUN AVE NE STE 650
ALBUQUERQUE NM
87109-4670
US

IV. Provider business mailing address

1301 E ORANGEWOOD AVE
ANAHEIM CA
92805-6807
US

V. Phone/Fax

Practice location:
  • Phone: 800-249-1266
  • Fax:
Mailing address:
  • Phone: 800-249-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: