Healthcare Provider Details

I. General information

NPI: 1881234391
Provider Name (Legal Business Name): JASON EDWARD MEADORS SR. RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 A ST
ANTIOCH CA
94509-2331
US

IV. Provider business mailing address

369 PECAN PL
BRENTWOOD CA
94513-1911
US

V. Phone/Fax

Practice location:
  • Phone: 925-978-2873
  • Fax: 925-757-0411
Mailing address:
  • Phone: 925-812-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: