Individual
JASON GREGORY DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 W STEWART DR, ORANGE, CA 92868-3849
(714) 633-9111
(714) 744-8695
Mailing address
PO BOX 1628, ORANGE, CA 92856-0628
(714) 619-4730
(714) 560-1585
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A91285
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A912850
BLUE SHIELD
CA
05
—
00A912850
—
CA
Enumeration date
07/25/2006
Last updated
02/19/2015
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