Healthcare Provider Details

I. General information

NPI: 1891959730
Provider Name (Legal Business Name): JONATHAN D WOOLERY MD, MPH, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 BARTON RD # 21-301
GRAND TERRACE CA
92313-5030
US

IV. Provider business mailing address

22400 BARTON RD # 21-301
GRAND TERRACE CA
92313-5030
US

V. Phone/Fax

Practice location:
  • Phone: 949-378-8250
  • Fax:
Mailing address:
  • Phone: 949-378-8250
  • Fax: 714-539-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number43599
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA104883
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44469
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA104883
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number18055
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number44469
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008018595
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44469
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number30139
License Number StateAL
# 10
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number43599
License Number StateKY
# 11
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number37062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: