Provider Demographics
NPI:1215174602
Name:TSUKAMAKI, JASON CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:TSUKAMAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 N RAFAEL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0956
Mailing Address - Country:US
Mailing Address - Phone:559-439-2176
Mailing Address - Fax:
Practice Address - Street 1:6355 N RAFAEL AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0956
Practice Address - Country:US
Practice Address - Phone:559-439-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine