Provider Demographics
NPI:1144252230
Name:JASON, WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:JASON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 MICHENER LN
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5154
Mailing Address - Country:US
Mailing Address - Phone:949-589-3346
Mailing Address - Fax:949-589-3346
Practice Address - Street 1:2362 MORSE AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6234
Practice Address - Country:US
Practice Address - Phone:949-863-9103
Practice Address - Fax:949-863-1337
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical