Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | A79829 | CA |
NPI | 1063490670 |
---|---|
Provider Name | Dr. Jonathan S. Fisher |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A798290 | (05) | CA |
H85350 | (02) | CA |