Provider Demographics
NPI:1851061352
Name:BAJARIAS, JADE ALIVIO (NP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALIVIO
Last Name:BAJARIAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2214
Mailing Address - Country:US
Mailing Address - Phone:747-477-1411
Mailing Address - Fax:
Practice Address - Street 1:1130 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2214
Practice Address - Country:US
Practice Address - Phone:747-477-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1366942666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherCASH, INSURANCE