Provider Demographics
NPI:1902113186
Name:JASON A. BLACK M.D., INC.
Entity Type:Organization
Organization Name:JASON A. BLACK M.D., INC.
Other - Org Name:VALLEY INTERNAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-491-4201
Mailing Address - Street 1:24680 JEFFERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9023
Mailing Address - Country:US
Mailing Address - Phone:951-677-2252
Mailing Address - Fax:951-677-3838
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-677-2252
Practice Address - Fax:951-677-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care