Provider Demographics
NPI:1437804655
Name:NYAGOL, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:NYAGOL
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 1:2209 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4419
Mailing Address - Country:US
Mailing Address - Phone:916-632-1330
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:2209 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4419
Practice Address - Country:US
Practice Address - Phone:916-632-4419
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician