Provider Demographics
NPI:1528102076
Name:THOMAS, JASON (CCP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MASSOL AVE
Mailing Address - Street 2:#107
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7248
Mailing Address - Country:US
Mailing Address - Phone:408-395-6863
Mailing Address - Fax:
Practice Address - Street 1:347 MASSOL AVE
Practice Address - Street 2:#107
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7248
Practice Address - Country:US
Practice Address - Phone:408-395-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA999072-1175246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other