Healthcare Provider Details

I. General information

NPI: 1891774113
Provider Name (Legal Business Name): JONATHAN DELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SAN MARIN DR
NOVATO CA
94945-1100
US

IV. Provider business mailing address

97 SAN MARIN DR
NOVATO CA
94945-1100
US

V. Phone/Fax

Practice location:
  • Phone: 415-899-7412
  • Fax:
Mailing address:
  • Phone: 415-899-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG88021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: