Provider Demographics
NPI:1386309490
Name:MCKINNEY, JASON MARCAS SR
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MARCAS
Last Name:MCKINNEY
Suffix:SR
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 1:4747 JURUPA AVE APT 89
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1960
Mailing Address - Country:US
Mailing Address - Phone:909-234-8640
Mailing Address - Fax:
Practice Address - Street 1:4747 JURUPA AVE APT 89
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1960
Practice Address - Country:US
Practice Address - Phone:909-234-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide