Jason Lee Pimentel, RAC #15174

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RAC15174 Issued in CA

Practice address

455 K St
Crescent City, CA 95531-4107

Phone

(707) 464-7224

Fax

(707) 465-4272

NPI assigned

Mar 23, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1144979360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 K ST",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955314107",
            "telephone_number": "707-464-7224",
            "fax_number": "707-465-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 K ST",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955314107",
            "telephone_number": "707-464-7224",
            "fax_number": "707-465-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIMENTEL",
        "first_name": "JASON",
        "middle_name": "LEE",
        "credential": "RAC #15174",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RAC15174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandy Gail Penner, RDH
• Luana Pennington, BSN, RN
• Celia Perez, ACSW
• Margo M Pfunder, CNM
• Robert Ming Phang, D.D.S.
• Stephania Pipinos, NCBTMB
• Laurel Plunkett
• Heather Christine Polen
• Kady Noel Pomerleau-Corpstein
• Sarah Jo Pond, IBCLC

• Addiction (Substance Use Disorder) Counselor in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.