Healthcare Provider Details

I. General information

NPI: 1982063616
Provider Name (Legal Business Name): JA-NEL MASADAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR STE 125
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

3493 SUMMIT WAY
ANTIOCH CA
94509-6255
US

V. Phone/Fax

Practice location:
  • Phone: 925-412-0884
  • Fax:
Mailing address:
  • Phone: 510-778-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCICA02780320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: