Provider Demographics
NPI:1740845577
Name:JARA, DAVID ANTHONY (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:JARA
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:ANTHONY
Other - Last Name:JARA URETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1931 N CLEVELAND ST APT 511
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4120
Mailing Address - Country:US
Mailing Address - Phone:240-478-0313
Mailing Address - Fax:
Practice Address - Street 1:8301 ARLINGTON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-204-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001725231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist