Provider Demographics
NPI:1255631560
Name:FEZIAN, JAYAD M
Entity type:Individual
Prefix:MR
First Name:JAYAD
Middle Name:M
Last Name:FEZIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GLENALMOND LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0911
Mailing Address - Country:US
Mailing Address - Phone:949-742-1366
Mailing Address - Fax:
Practice Address - Street 1:50 GLENALMOND LN
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0911
Practice Address - Country:US
Practice Address - Phone:949-742-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN236718164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse