Healthcare Provider Details

I. General information

NPI: 1467990390
Provider Name (Legal Business Name): JONATHAN UNIAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS#68
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1520 RODNEY DR APT 111
LOS ANGELES CA
90027-5338
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2122
  • Fax: 323-361-7926
Mailing address:
  • Phone: 909-725-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number146515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: