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NPI Code Detail

MEDICARE: MR. MARTIN JASON OMOTO M.S., BCBA

MEDICARE: MR. MARTIN JASON OMOTO M.S., BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1275074288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARTIN JASON OMOTO M.S., BCBA
Provider Business Mailing Address
First Line : 662 ENCINITAS BLVD STE 208
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-6789
Country : US
Telephone Number : 760-815-9968
Fax Number :
Provider Business Practice Location Address
First Line : 3550 CAMINO DEL RIO N STE 104
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1738
Country : US
Telephone Number : 760-815-9968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2017
Last Update Date : 11/17/2021

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