Provider Demographics
NPI:1215392394
Name:THOMPSON, JASON ALEX (RN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALEX
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1505
Mailing Address - Country:US
Mailing Address - Phone:310-720-1301
Mailing Address - Fax:
Practice Address - Street 1:209 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1505
Practice Address - Country:US
Practice Address - Phone:310-720-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95058313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse