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NPI Code Detail

MEDICARE: MR. JASON RUSSEL D'AMICO LPT

MEDICARE: MR. JASON RUSSEL D'AMICO LPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorCA
2167G00000XLicensed Psychiatric TechnicianPT27519CA

General Provider Information

NPI Number : 1184722316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON RUSSEL D'AMICO LPT
Provider Business Mailing Address
First Line : 405 W 5TH ST STE 550
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4519
Country : US
Telephone Number : 714-834-4707
Fax Number :
Provider Business Practice Location Address
First Line : 1030 W WARNER AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92707-3147
Country : US
Telephone Number : 714-834-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/22/2023

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