Provider Demographics
NPI:1902047426
Name:CRONIN, JASON (LAC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:CRONIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1127 N BRANCIFORTE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1013
Mailing Address - Country:US
Mailing Address - Phone:831-423-6313
Mailing Address - Fax:
Practice Address - Street 1:1127 N BRANCIFORTE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1013
Practice Address - Country:US
Practice Address - Phone:831-423-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist