Healthcare Provider Details

I. General information

NPI: 1831167212
Provider Name (Legal Business Name): JONATHAN MEDENILLA ZUNIGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 TEAYS VALLEY ROAD SUITE A
HURRICANE WV
25526-9622
US

IV. Provider business mailing address

3847 TEAYS VALLEY ROAD SUITE A
HURRICANE WV
25526-9622
US

V. Phone/Fax

Practice location:
  • Phone: 304-760-8904
  • Fax: 304-760-8913
Mailing address:
  • Phone: 304-760-8904
  • Fax: 304-760-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20402
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: