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NPI Code Detail

MEDICARE: MR. JASON DAVIS

MEDICARE: MR. JASON DAVIS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1801944350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON DAVIS
Provider Business Mailing Address
First Line : 28794 SANDPIPER RD
Second Line :
City : TOLLHOUSE
State : CA
Zip : 93667-9711
Country : US
Telephone Number : 559-855-8534
Fax Number :
Provider Business Practice Location Address
First Line : 3707 E SHIELDS AVE
Second Line :
City : FRESNO
State : CA
Zip : 93726-7029
Country : US
Telephone Number : 559-229-9040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ MR. JASON DAVIS ” Practice Location

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