Healthcare Provider Details

I. General information

NPI: 1740774082
Provider Name (Legal Business Name): JASON ADAM HULL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MORRO AVE STE C
MORRO BAY CA
93442-2233
US

IV. Provider business mailing address

1414 E MAIN ST STE 201
SANTA MARIA CA
93454-4890
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-7313
  • Fax: 805-772-0395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT018785
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: