Healthcare Provider Details

I. General information

NPI: 1770603391
Provider Name (Legal Business Name): JONATHAN BECHTEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W LOS ANGELES AVE
MOORPARK CA
93021-1820
US

IV. Provider business mailing address

1715 CRESTON CT
SIMI VALLEY CA
93065-0548
US

V. Phone/Fax

Practice location:
  • Phone: 805-529-5370
  • Fax: 805-529-5397
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 17596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: