Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043469901 |
---|---|
Provider Name | Mr. Jonathan Fidani |
First Address | Glendora, CA 91740-6106 |
Second Address | South Pasadena, CA 91030-2919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 16/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7184 | MEDICAL (01) | CA |
7368 | MEDICAL (01) | CA |
7667 | MEDICAL (01) | CA |
7708 | MEDICAL (01) | CA |