Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A135948 | CA |
NPI | 1417188061 |
---|---|
Provider Name | Dr. Jason Edward Jagodzinski |
First Address | San Francisco, CA 94158-2549 |
Second Address | Oakland, CA 94609-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 10/09/2015 |