Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RNP234219 | AZ |
NPI | 1023652039 |
---|---|
Provider Name | Jabez Barajas |
First Address | Glendale, AZ 85308-1260 |
Second Address | Glendale, AZ 85308-1260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2019 |
Last Update Date | 24/06/2021 |