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General NPI Number Information
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NPI Number | 1154859403
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Entity Type | Individual
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Provider Name | JONATHAN SCOTT SURFACE MA, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 1000 EL CAMINO REAL
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City | ATHERTON
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State | CA
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Zip | 94027-4300
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Country | US
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Telephone | 650-543-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 680 CEDAR ST APT 6
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City | SAN CARLOS
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State | CA
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Zip | 94070-3038
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Country | US
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Telephone | 530-400-5524
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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