Provider Demographics
NPI:1124474432
Name:AZIE, JASON A
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:AZIE
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 1:9507 ARROW RTE BLDG 7-C
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4580
Mailing Address - Country:US
Mailing Address - Phone:909-302-3253
Mailing Address - Fax:
Practice Address - Street 1:9507 ARROW RTE BLDG 7-C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4580
Practice Address - Country:US
Practice Address - Phone:909-302-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2935284343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)