Provider Demographics
NPI:1104302504
Name:HUMS, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HUMS
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 1:658 COASTAL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4318
Mailing Address - Country:US
Mailing Address - Phone:619-591-9393
Mailing Address - Fax:
Practice Address - Street 1:900 OTAY LAKES RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7297
Practice Address - Country:US
Practice Address - Phone:619-216-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802438163WC0200X
146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic