Provider Demographics
NPI:1871385674
Name:HARGES, JAKARTA
Entity type:Individual
Prefix:
First Name:JAKARTA
Middle Name:
Last Name:HARGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32723 NEWHAM CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8300
Mailing Address - Country:US
Mailing Address - Phone:909-565-0555
Mailing Address - Fax:
Practice Address - Street 1:345 TUFFA CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5540
Practice Address - Country:US
Practice Address - Phone:909-565-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty