Provider Demographics
NPI:1023835139
Name:VILLARUZ, JASON (EMS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:VILLARUZ
Suffix:
Gender:M
Credentials:EMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37164 SAINT CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3215
Mailing Address - Country:US
Mailing Address - Phone:707-246-3971
Mailing Address - Fax:
Practice Address - Street 1:201 W MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1701
Practice Address - Country:US
Practice Address - Phone:707-246-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3690513146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic