Provider Demographics
NPI:1427614700
Name:MCMULLEN, JASON (ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 36TH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4434
Mailing Address - Country:US
Mailing Address - Phone:619-405-5736
Mailing Address - Fax:
Practice Address - Street 1:3421 36TH ST APT 15
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4434
Practice Address - Country:US
Practice Address - Phone:619-405-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty