Provider Demographics
NPI:1639833189
Name:SPEED, JAHQUON TYLER
Entity Type:Individual
Prefix:
First Name:JAHQUON
Middle Name:TYLER
Last Name:SPEED
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 1:1855 W KATELLA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3432
Mailing Address - Country:US
Mailing Address - Phone:714-399-3480
Mailing Address - Fax:714-399-3481
Practice Address - Street 1:1520 NUTMEG PL SUITE 110 COSTA MESA 92626
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator