Healthcare Provider Details

I. General information

NPI: 1265149728
Provider Name (Legal Business Name): JONATHAN PATRICK ROHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N GREENFIELD RD APT 156
MESA AZ
85205-7837
US

IV. Provider business mailing address

220 N GREENFIELD RD APT 156
MESA AZ
85205-7837
US

V. Phone/Fax

Practice location:
  • Phone: 623-329-4780
  • Fax:
Mailing address:
  • Phone: 623-232-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: