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General NPI Number Information
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NPI Number | 1417032376
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Entity Type | Individual
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Provider Name | JONATHAN GARTH BRISKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 101 S SAN MATEO DR STE 213
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City | SAN MATEO
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State | CA
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Zip | 94401-3843
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Country | US
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Telephone | 650-373-0170
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Fax | 650-347-8966
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Provider Business Mailing Address
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Address Line | 101 S SAN MATEO DR STE 213
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City | SAN MATEO
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State | CA
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Zip | 94401-3843
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Country | US
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Telephone | 650-373-0170
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Fax | 650-347-8966
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G31838
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License Number State | CA
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