Healthcare Provider Details

I. General information

NPI: 1780144428
Provider Name (Legal Business Name): JONATHAN BARRY FOURNIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-1550
  • Fax: 562-933-1501
Mailing address:
  • Phone: 562-933-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA179369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA179369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: