Provider Demographics
NPI:1942492889
Name:ASEMOTA, JARED OSAZE (LVN)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:OSAZE
Last Name:ASEMOTA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 RAYEN ST APT 310
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1601
Mailing Address - Country:US
Mailing Address - Phone:818-428-8363
Mailing Address - Fax:
Practice Address - Street 1:18440 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1956
Practice Address - Country:US
Practice Address - Phone:818-428-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN206599164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse