Provider Demographics
NPI:1619986965
Name:GROOMER, JASON EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
Last Name:GROOMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6520 PLATT AVENUE
Mailing Address - Street 2:# 827
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-825-7174
Mailing Address - Fax:818-579-9233
Practice Address - Street 1:18531 ROSCOE BLVD STE 215
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5975
Practice Address - Country:US
Practice Address - Phone:818-700-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8134204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM