MEDICARE: MR. JASON TANCO OTR/L

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	314000000X	Skilled Nursing Facility	13020	CA

General Provider Information

NPI Number	:	1700264322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON TANCO OTR/L

Provider Business Mailing Address
First Line	:	4700 ELVAS AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2250
Country	:	US
Telephone Number	:	916-455-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 ELVAS AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2250
Country	:	US
Telephone Number	:	916-755-0570
Fax Number	:

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

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	02/11/2022

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