Provider Demographics
NPI:1063937225
Name:JARRETT, MUTIATU MORAYO (FNP)
Entity type:Individual
Prefix:
First Name:MUTIATU
Middle Name:MORAYO
Last Name:JARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22316 HIDEOUT CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5700
Mailing Address - Country:US
Mailing Address - Phone:818-209-3506
Mailing Address - Fax:
Practice Address - Street 1:22316 HIDEOUT CT
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5700
Practice Address - Country:US
Practice Address - Phone:818-209-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty