MEDICARE: JAN KAREL MASEK

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

General Provider Information

NPI Number	:	1740012244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN KAREL MASEK

Provider Business Mailing Address
First Line	:	PO BOX 78835
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-0835
Country	:	US
Telephone Number	:	424-364-8086
Fax Number	:

Provider Business Practice Location Address
First Line	:	5368 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6020
Country	:	US
Telephone Number	:	323-935-7484
Fax Number	:

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

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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