Healthcare Provider Details

I. General information

NPI: 1790609998
Provider Name (Legal Business Name): JASON KURIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR
SANTA ROSA CA
95405-4897
US

IV. Provider business mailing address

1853 CASTLE DR
PETALUMA CA
94954-8505
US

V. Phone/Fax

Practice location:
  • Phone: 707-525-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number72817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: