Provider Demographics
NPI:1700406147
Name:JARED D. AMENT, MD, MPH, PC
Entity Type:Organization
Organization Name:JARED D. AMENT, MD, MPH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:AMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:617-721-4673
Mailing Address - Street 1:7320 WOODLAKE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1401
Mailing Address - Country:US
Mailing Address - Phone:800-899-0101
Mailing Address - Fax:
Practice Address - Street 1:7320 WOODLAKE AVE STE 215
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1401
Practice Address - Country:US
Practice Address - Phone:800-899-0101
Practice Address - Fax:310-870-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356653927OtherPERSONAL NPI