Provider Demographics
NPI:1013208735
Name:WARREN, JASON L (CO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:WARREN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 N EL DORADO ST STE ABC
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1324
Mailing Address - Country:US
Mailing Address - Phone:209-944-5517
Mailing Address - Fax:
Practice Address - Street 1:1236 N EL DORADO ST STE ABC
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1324
Practice Address - Country:US
Practice Address - Phone:209-944-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist