MEDICARE: MR. JONATHAN BLIC ARPON MASAYON LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN242379	CA

General Provider Information

NPI Number	:	1124395116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN BLIC ARPON MASAYON LVN

Provider Business Mailing Address
First Line	:	2018 LAS VEGAS AVE. APT. 9
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2139
Country	:	US
Telephone Number	:	626-274-1431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 LAS VEGAS AVE APT 9
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2735
Country	:	US
Telephone Number	:	626-274-1431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	11/19/2011

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