Active NPI
Reynaldo Maranan Bulaon, P.A-C
- Physician Assistant
- Antioch, CA
National Provider Identifier
1659396760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16855
- Practice address
- 3901 Lone Tree Way
Antioch, CA 94509-6200 - Phone
- (925) 779-7273
- Fax
- (925) 779-7281
- NPI assigned
- Jul 12, 2006
- Last updated
- Feb 4, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16855 | CA | Primary |
Addresses
Primary practice location
3901 Lone Tree Way
Antioch, CA 94509-6200
Mailing address
2100 Powell St
Ste 920
Emeryville, CA 94608-1826
Phone (510) 350-2600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16855 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202083200000",
"number": "1659396760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST",
"address_2": "STE 920",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081826",
"telephone_number": "510-350-2600",
"fax_number": "510-879-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 LONE TREE WAY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945096200",
"telephone_number": "925-779-7273",
"fax_number": "925-779-7281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULAON",
"first_name": "REYNALDO",
"middle_name": "MARANAN",
"credential": "P.A-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2008-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA16855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.