Healthcare Provider Details

I. General information

NPI: 1336061910
Provider Name (Legal Business Name): MR. JASON ALBERT VERRECCHIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18003 SEQUOIA ST
HESPERIA CA
92345-4936
US

IV. Provider business mailing address

18003 SEQUOIA ST
HESPERIA CA
92345-4936
US

V. Phone/Fax

Practice location:
  • Phone: 909-788-6032
  • Fax:
Mailing address:
  • Phone: 909-788-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: