Healthcare Provider Details

I. General information

NPI: 1346157021
Provider Name (Legal Business Name): JASON ANTHONY BLAIN BERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 SAN DIEGO AVE STE A150
SAN DIEGO CA
92110-2983
US

IV. Provider business mailing address

2251 SAN DIEGO AVE STE A150
SAN DIEGO CA
92110-2983
US

V. Phone/Fax

Practice location:
  • Phone: 619-675-6008
  • Fax:
Mailing address:
  • Phone: 619-675-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: