Healthcare Provider Details

I. General information

NPI: 1417188061
Provider Name (Legal Business Name): JASON EDWARD JAGODZINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 52ND ST OPC 1ST FLOOR, ORTHOPAEDICS CLINIC
OAKLAND CA
94609-1810
US

IV. Provider business mailing address

550 16TH ST UCSF ORTHOPAEDIC SURGERY, 5TH FLOOR, BOX 3212
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 415-514-1519
  • Fax: 415-476-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA135948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: