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General NPI Number Information
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NPI Number | 1033900709
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Entity Type | Individual
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Provider Name | JONATHAN JOSEPH KOREL
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 714 TIVERTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-8361
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Country | US
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Telephone | 310-206-3904
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Fax |
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Provider Business Mailing Address
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Address Line | 783 SINGING VISTA DR
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City | EL CAJON
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State | CA
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Zip | 92019-2739
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Country | US
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Telephone | 619-866-1877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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