Provider Demographics
NPI:1922738905
Name:SWEAZA, ROBERT JASON (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JASON
Last Name:SWEAZA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 YORBA ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2041
Mailing Address - Country:US
Mailing Address - Phone:714-393-6111
Mailing Address - Fax:
Practice Address - Street 1:14101 YORBA ST STE 104
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2041
Practice Address - Country:US
Practice Address - Phone:714-393-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1063971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical