Healthcare Provider Details

I. General information

NPI: 1356900948
Provider Name (Legal Business Name): JASON SAJULAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MORRO AVE STE C
MORRO BAY CA
93442
US

IV. Provider business mailing address

1400 E. CHURCH STREET ATTENTION: MEDICAL STAFF OFFICE
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-7313
  • Fax:
Mailing address:
  • Phone: 805-739-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56851
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE006983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: