Healthcare Provider Details

I. General information

NPI: 1447791371
Provider Name (Legal Business Name): JASON SANDSNESS (HHP) (AB) (PT) (SEC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CAMINO DEL RIO S
SAN DIEGO CA
92108-3717
US

IV. Provider business mailing address

3155 CLAIREMONT DR APT 4
SAN DIEGO CA
92117-6438
US

V. Phone/Fax

Practice location:
  • Phone: 619-212-1855
  • Fax:
Mailing address:
  • Phone: 619-212-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number43130
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number43130
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number43130
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number43130
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number43130
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: