Healthcare Provider Details

I. General information

NPI: 1801423769
Provider Name (Legal Business Name): JONATHAN THORPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 COMMODORE DR
VERDI NV
89439-8064
US

IV. Provider business mailing address

1155 MILL ST BLDG 55
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 909-354-2704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23998
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: