Basic Information
Provider Information
NPI: 1003926833
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JARRIN
FirstName: DIEGO
MiddleName: FERNANDO
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2367 DEERPARK DR
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921101138
CountryCode: US
TelephoneNumber: 6192765316
FaxNumber:  
Practice Location
Address1: 8810 RIO SAN DIEGO DR
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921081622
CountryCode: US
TelephoneNumber: 6194005050
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/30/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA60434CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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