Healthcare Provider Details

I. General information

NPI: 1164913133
Provider Name (Legal Business Name): JASON SINGH ROLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON SINGH ROLEY DR. JASON ROLEY

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

IV. Provider business mailing address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

V. Phone/Fax

Practice location:
  • Phone: 669-245-3428
  • Fax: 408-800-4095
Mailing address:
  • Phone: 669-245-3428
  • Fax: 408-800-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA165015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: