Healthcare Provider Details

I. General information

NPI: 1396199402
Provider Name (Legal Business Name): JASON MCGRAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 BLACK AVE STE F
PLEASANTON CA
94566-6139
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8123
US

V. Phone/Fax

Practice location:
  • Phone: 925-484-3507
  • Fax: 925-484-3556
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: