Healthcare Provider Details

I. General information

NPI: 1215866868
Provider Name (Legal Business Name): JEREMIAH NASH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 WOODLARK DR
SUISUN CITY CA
94585-2244
US

IV. Provider business mailing address

602 WOODLARK DR
SUISUN CITY CA
94585-2244
US

V. Phone/Fax

Practice location:
  • Phone: 925-901-0219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number487003584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: