Provider Demographics
NPI:1558778274
Name:SZYMANSKI, JARED JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:JOHN
Last Name:SZYMANSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2322
Mailing Address - Country:US
Mailing Address - Phone:949-557-0610
Mailing Address - Fax:
Practice Address - Street 1:370 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2322
Practice Address - Country:US
Practice Address - Phone:949-557-0610
Practice Address - Fax:949-557-1610
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3957390200000X
MN62269207Q00000X
CA20A18498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program