Healthcare Provider Details

I. General information

NPI: 1609030683
Provider Name (Legal Business Name): JASON AQUINO BURANDAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OAK PARK BLVD SUITE 101
ARROYO GRANDE CA
93420-1800
US

IV. Provider business mailing address

860 OAK PARK BLVD SUITE 101
ARROYO GRANDE CA
93420-1800
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-3685
  • Fax: 805-481-5245
Mailing address:
  • Phone: 805-481-3685
  • Fax: 805-481-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: