Healthcare Provider Details

I. General information

NPI: 1750446332
Provider Name (Legal Business Name): JASON A. MCCANN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 KIELY BLVD
SANTA CLARA CA
95051-5329
US

IV. Provider business mailing address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: