Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1003240706 |
---|---|
Provider Name | Mr. Jonathan Hearn |
First Address | Van Nuys, CA 91405-3087 |
Second Address | Van Nuys, CA 91405-3087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |