Individual
JASON TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2447 CARSON AVE, CLOVIS, CA 93611-6548
(408) 821-6101
Mailing address
2447 CARSON AVE, CLOVIS, CA 93611-6548
(408) 821-6101
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
11188
CA
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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