Provider Demographics
NPI:1881870285
Name:FRIEDMAN, JASON TODD (CPO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TODD
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15644 POMERADO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2400
Mailing Address - Country:US
Mailing Address - Phone:858-613-0958
Mailing Address - Fax:858-613-0959
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-613-0958
Practice Address - Fax:858-613-0959
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO1661335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000850Medicaid