Healthcare Provider Details

I. General information

NPI: 1023998564
Provider Name (Legal Business Name): JASON DOUGLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 10/24/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

1255 GROVE ST APT 104
SAN FRANCISCO CA
94117-1547
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-1000
  • Fax:
Mailing address:
  • Phone: 415-505-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: