Provider Demographics
NPI:1255504189
Name:WUEST, JASON C
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:WUEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4632
Mailing Address - Country:US
Mailing Address - Phone:800-994-0454
Mailing Address - Fax:626-628-3956
Practice Address - Street 1:1536 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4632
Practice Address - Country:US
Practice Address - Phone:800-994-0454
Practice Address - Fax:626-628-3956
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3965460001Medicare NSC