Provider Demographics
NPI:1073587671
Name:SILVA, JASON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ALPINE BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1104
Mailing Address - Country:US
Mailing Address - Phone:619-445-6200
Mailing Address - Fax:619-320-3343
Practice Address - Street 1:1620 ALPINE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1104
Practice Address - Country:US
Practice Address - Phone:619-445-6200
Practice Address - Fax:619-320-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A926860Medicaid
CA00A926860Medicaid
CAI48918Medicare UPIN