Provider Demographics
NPI:1730782665
Name:TARIN, JESSE RAY (LVN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:RAY
Last Name:TARIN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23155 GUINEA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3829
Mailing Address - Country:US
Mailing Address - Phone:949-922-9843
Mailing Address - Fax:
Practice Address - Street 1:23155 GUINEA ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3829
Practice Address - Country:US
Practice Address - Phone:949-922-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse