Healthcare Provider Details

I. General information

NPI: 1538123732
Provider Name (Legal Business Name): JONATHAN A. DUNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR
SAN DIEGO CA
92130-3318
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3100
  • Fax: 858-784-5933
Mailing address:
  • Phone: 858-764-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA62557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: