Healthcare Provider Details

I. General information

NPI: 1174456883
Provider Name (Legal Business Name): MACMASTER PSYCHIATRIC SERVICES A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S BARKER ST
MOUNTAIN HOUSE CA
95391-1473
US

IV. Provider business mailing address

1510 S BARKER ST
MOUNTAIN HOUSE CA
95391-1473
US

V. Phone/Fax

Practice location:
  • Phone: 559-776-8864
  • Fax:
Mailing address:
  • Phone: 559-776-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB MARTIN MACMASTER
Title or Position: OWNER
Credential: PMHNP
Phone: 559-776-8864