Provider Demographics
NPI:1689794976
Name:ROSALES, JASON SALVADOR (LICENSED PSYCH TECH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:SALVADOR
Last Name:ROSALES
Suffix:
Gender:M
Credentials:LICENSED PSYCH TECH
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Mailing Address - Street 1:1233 SHADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1426
Mailing Address - Country:US
Mailing Address - Phone:209-468-3760
Mailing Address - Fax:209-468-3779
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-3760
Practice Address - Fax:209-468-3779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT29038167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician