MEDICARE: MARCOS DANIEL JASSO MA LEVEL

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
1	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1194361006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCOS DANIEL JASSO MA LEVEL

Provider Business Mailing Address
First Line	:	4515 OCEAN VIEW BLVD STE 320
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1438
Country	:	US
Telephone Number	:	818-937-0882
Fax Number	:	818-937-0883

Provider Business Practice Location Address
First Line	:	17037 CHATSWORTH ST STE 206
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5874
Country	:	US
Telephone Number	:	818-937-0882
Fax Number	:	818-937-0883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	11/26/2019

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