Healthcare Provider Details

I. General information

NPI: 1508314808
Provider Name (Legal Business Name): JONATHAN ABRAHAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 BACON ST
CONCORD CA
94520-2022
US

IV. Provider business mailing address

20130 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5340
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-3933
  • Fax: 925-609-7255
Mailing address:
  • Phone: 510-581-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: