Provider Demographics
NPI:1043314115
Name:JARET, LEROY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:RICHARD
Last Name:JARET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 WESTKNOLL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1338
Mailing Address - Country:US
Mailing Address - Phone:858-273-6216
Mailing Address - Fax:
Practice Address - Street 1:5323 WESTKNOLL DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1338
Practice Address - Country:US
Practice Address - Phone:858-273-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG181992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90532Medicare UPIN