Provider Demographics
NPI:1700869005
Name:CAMPBELL, JARED SCOTT (RD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:SCOTT
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 N LOS FELICES RD
Mailing Address - Street 2:APT 204
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1979
Mailing Address - Country:US
Mailing Address - Phone:760-534-5954
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE E421
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-534-5954
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA951340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered