Provider Demographics
NPI:1033670419
Name:BAPTIST, JARED SAMUEL
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:SAMUEL
Last Name:BAPTIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34590 COUNTY LINE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5398
Mailing Address - Country:US
Mailing Address - Phone:909-795-4255
Mailing Address - Fax:909-795-4438
Practice Address - Street 1:34590 COUNTY LINE RD STE 7
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5398
Practice Address - Country:US
Practice Address - Phone:909-795-4255
Practice Address - Fax:909-795-4438
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist