Provider Demographics
NPI:1982063616
Name:MASADAS, JA-NEL
Entity Type:Individual
Prefix:
First Name:JA-NEL
Middle Name:
Last Name:MASADAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3493 SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6255
Mailing Address - Country:US
Mailing Address - Phone:510-778-0036
Mailing Address - Fax:
Practice Address - Street 1:2731 SYSTRON DR STE 250
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1355
Practice Address - Country:US
Practice Address - Phone:925-412-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CACICA02780320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker