| Doctor Name: | JASON WILLOUGHBY |
| NPI Number: | 1023440963 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2236 Mulberry Ln Placerville, CA - 95667 |
| Business Phone Number: | 5303916929 |
| Business Fax Number: | |
| Mailing Address: | 2236 Mulberry Ln, PLACERVILLE |
| State: | CA |
| Postal Code: | 956677783 |
| Phone Number: | 5303916929 |
| Fax Number: | |
| NPI Enumeration Date: | 08/02/2013 |
| NPI Last Update Date: | 08/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2472E0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Other |
| Taxonomy Specialization: | EEG |
| Taxonomy Definition: | |