MEDICARE: BRIAN E JASKI M.D.

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	207RC0000X	Cardiovascular Disease Physician	G55011	CA
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	G55011	CA
3	207RI0011X	Interventional Cardiology Physician	G55011	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194706242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN E JASKI M.D.

Provider Business Mailing Address
First Line	:	3131 BERGER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4233
Country	:	US
Telephone Number	:	858-244-6800
Fax Number	:	858-244-6909

Provider Business Practice Location Address
First Line	:	3131 BERGER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4233
Country	:	US
Telephone Number	:	858-244-6800
Fax Number	:	858-244-6909

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/17/2017

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Directions to “ BRIAN E JASKI M.D.” Practice Location

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