Healthcare Provider Details

I. General information

NPI: 1871639823
Provider Name (Legal Business Name): JONATHAN PAUL AUTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA SUITE 334
LAGUNA HILLS CA
92653-3616
US

IV. Provider business mailing address

23961 CALLE DE LA MAGDALENA SUITE 334
LAGUNA HILLS CA
92653-3616
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-5437
  • Fax: 949-951-2715
Mailing address:
  • Phone: 949-951-5437
  • Fax: 949-951-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: