Provider Demographics
NPI:1265166250
Name:JARRAR, DEYANAH
Entity type:Individual
Prefix:
First Name:DEYANAH
Middle Name:
Last Name:JARRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35653 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9003
Mailing Address - Country:US
Mailing Address - Phone:951-579-8525
Mailing Address - Fax:
Practice Address - Street 1:35653 RUTH AVE
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9003
Practice Address - Country:US
Practice Address - Phone:951-579-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-12-16
Deactivation Date:2022-12-26
Deactivation Code:
Reactivation Date:2023-07-17
Provider Licenses
StateLicense IDTaxonomies
CA30628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist