Healthcare Provider Details

I. General information

NPI: 1710668728
Provider Name (Legal Business Name): JONAH GABRIEL MARANON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD
PLEASANTON CA
94588-8517
US

IV. Provider business mailing address

2247 NORMANDY CIR
LIVERMORE CA
94550-8226
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax:
Mailing address:
  • Phone: 925-337-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: