Individual
JACOB JOHN MASSARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1800 COOKS HILL RD STE F, CENTRALIA, WA 98531-9162
(360) 669-0335
(360) 736-2967
Mailing address
2690 NE KRESKY AVE, CHEHALIS, WA 98532-2412
(360) 330-9595
(360) 330-9560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61478292
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2261548
—
WA
Enumeration date
08/11/2023
Last updated
10/19/2023
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