MEDICARE: JASON DANIEL MARTIN

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	Y9222448	CA

General Provider Information

NPI Number	:	1619832128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON DANIEL MARTIN

Provider Business Mailing Address
First Line	:	7331 WYOMING ST APT B
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3872
Country	:	US
Telephone Number	:	657-400-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	7331 WYOMING ST APT B
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3872
Country	:	US
Telephone Number	:	657-400-6428
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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