Individual
JASON MICHAEL KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4101
Mailing address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4101
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
692594
CA
Other
Enumeration date
12/22/2017
Last updated
12/22/2017
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