Provider Demographics
NPI:1063634822
Name:SERVATIUS, JASON A (ND)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:SERVATIUS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SHATTUCK AVE #306
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709
Mailing Address - Country:US
Mailing Address - Phone:415-702-3500
Mailing Address - Fax:
Practice Address - Street 1:2550 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2724
Practice Address - Country:US
Practice Address - Phone:415-702-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath