Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A125279 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | A125279 | CA |
NPI | 1043478902 |
---|---|
Provider Name | Javan Jonathon Nation |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 14/03/2016 |