Healthcare Provider Details

I. General information

NPI: 1215158456
Provider Name (Legal Business Name): JASON S OKUHARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENDA DR
RIVERVIEW FL
33578-5835
US

IV. Provider business mailing address

10010 KENDA DR
RIVERVIEW FL
33578-5835
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-0803
  • Fax: 941-214-4973
Mailing address:
  • Phone: 727-365-0803
  • Fax: 941-214-4973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MB07898300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101028409
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS8993
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS8993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: