Healthcare Provider Details

I. General information

NPI: 1134190259
Provider Name (Legal Business Name): JONATHAN DAVID AUTEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

826 ORANGE AVE STE 427
CORONADO CA
92118-2619
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7427
  • Fax:
Mailing address:
  • Phone: 610-608-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberIN02002970A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberIN 02002970A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: