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General NPI Number Information
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NPI Number | 1528681202
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Entity Type | Individual
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Provider Name | JORDAN LAMASTERS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 6 WOODLAND RD STE 304
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City | SAINT HELENA
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State | CA
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Zip | 94574-9562
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Country | US
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Telephone | 707-963-7200
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Fax | 707-963-7203
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Provider Business Mailing Address
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Address Line | 4651 MARSHALL RD
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City | GARDEN VALLEY
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State | CA
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Zip | 95633-9306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58182
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License Number State | CA
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