Provider Demographics
NPI:1487291423
Name:DELOS ANGELES, JAYROD
Entity type:Individual
Prefix:MR
First Name:JAYROD
Middle Name:
Last Name:DELOS ANGELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAY ROD
Other - Middle Name:
Other - Last Name:DE LOS ANGELES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 LA CASA VIA STE 212
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3007
Mailing Address - Country:US
Mailing Address - Phone:925-939-8710
Mailing Address - Fax:925-939-8716
Practice Address - Street 1:120 LA CASA VIA STE 212
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3007
Practice Address - Country:US
Practice Address - Phone:925-939-8710
Practice Address - Fax:925-939-8716
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49843225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant