Provider Demographics
NPI:1154681534
Name:DAUGHETY, JASON D (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:DAUGHETY
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12842 STONE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2037
Mailing Address - Country:US
Mailing Address - Phone:619-929-4343
Mailing Address - Fax:
Practice Address - Street 1:16766 BERNARDO CENTER DR STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2502
Practice Address - Country:US
Practice Address - Phone:858-848-5249
Practice Address - Fax:415-728-9751
Is Sole Proprietor?:No
Enumeration Date:2012-05-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16016207L00000X, 207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine