Provider Demographics
NPI:1548795420
Name:ANDAL, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ANDAL
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 1:1241 SUMMIT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2280 DIAMOND BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5750
Practice Address - Country:US
Practice Address - Phone:925-483-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA838044163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse