MEDICARE: DR. JARED JOHN SZYMANSKI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	UO3957	FL
2	207Q00000X	Family Medicine Physician	62269	MN
3	207Q00000X	Family Medicine Physician	20A18498	CA

General Provider Information

NPI Number	:	1558778274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED JOHN SZYMANSKI D.O.

Provider Business Mailing Address
First Line	:	370 OCEAN AVE
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2322
Country	:	US
Telephone Number	:	949-557-0610
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 OCEAN AVE
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2322
Country	:	US
Telephone Number	:	949-557-0610
Fax Number	:	949-557-1610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	10/21/2022

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