Healthcare Provider Details

I. General information

NPI: 1972150787
Provider Name (Legal Business Name): JASON MARTIN MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 DELA VINA AVE
MONTEREY CA
93940-3974
US

IV. Provider business mailing address

343 DELA VINA AVE
MONTEREY CA
93940-3974
US

V. Phone/Fax

Practice location:
  • Phone: 831-440-7030
  • Fax: 831-647-3004
Mailing address:
  • Phone: 831-440-7030
  • Fax: 831-647-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: