Healthcare Provider Details

I. General information

NPI: 1881870285
Provider Name (Legal Business Name): JASON TODD FRIEDMAN C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 POMERADO RD SUITE 103
POWAY CA
92064-2400
US

IV. Provider business mailing address

15644 POMERADO RD SUITE 103
POWAY CA
92064-2400
US

V. Phone/Fax

Practice location:
  • Phone: 858-613-0958
  • Fax: 858-613-0959
Mailing address:
  • Phone: 858-613-0958
  • Fax: 858-613-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPO1661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: