Healthcare Provider Details

I. General information

NPI: 1144252230
Provider Name (Legal Business Name): WILLIAM JASON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 MORSE AVE
IRVINE CA
92614-6234
US

IV. Provider business mailing address

4 MICHENER LN
COTO DE CAZA CA
92679-5154
US

V. Phone/Fax

Practice location:
  • Phone: 949-863-9103
  • Fax: 949-863-1337
Mailing address:
  • Phone: 949-589-3346
  • Fax: 949-589-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: