Healthcare Provider Details

I. General information

NPI: 1700404936
Provider Name (Legal Business Name): JADEN C MUSTACCHIO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST MS M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-4196
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-980-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2484
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: