Provider Demographics
NPI:1184871089
Name:BAZILIAN, JASON D (DAOM, LAC, MTOM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:BAZILIAN
Suffix:
Gender:M
Credentials:DAOM, LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 OAKS NORTH DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1608
Mailing Address - Country:US
Mailing Address - Phone:858-676-6888
Mailing Address - Fax:
Practice Address - Street 1:12540 OAKS NORTH DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-676-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist