Healthcare Provider Details

I. General information

NPI: 1255850145
Provider Name (Legal Business Name): JASON ALLAN BRIGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 RACE ST
SAN JOSE CA
95126-3130
US

IV. Provider business mailing address

46 RACE ST
SAN JOSE CA
95126-3130
US

V. Phone/Fax

Practice location:
  • Phone: 408-961-9850
  • Fax:
Mailing address:
  • Phone: 408-961-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: