Provider Demographics
NPI:1205491115
Name:MABBAYAD, JASON (RN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MABBAYAD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74127 E PETUNIA PL
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2079
Mailing Address - Country:US
Mailing Address - Phone:760-799-4025
Mailing Address - Fax:760-323-3710
Practice Address - Street 1:2145 E TAHQUITZ CANYON WAY STE 3
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7020
Practice Address - Country:US
Practice Address - Phone:760-322-3700
Practice Address - Fax:760-322-3710
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health