Healthcare Provider Details

I. General information

NPI: 1104857572
Provider Name (Legal Business Name): JONATHAN HART CRESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SOQUEL AVE STE B
SANTA CRUZ CA
95062-2321
US

IV. Provider business mailing address

526 SOQUEL AVE., STE.B
SANTA CRUZ CA
95062-2321
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-1930
  • Fax:
Mailing address:
  • Phone: 831-427-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA24390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: