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General NPI Number Information
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NPI Number | 1609973882
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Entity Type | Organization
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Legal Business Name | JONATHAN NORDLICHT MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 3905 SACRAMENTO SUITE 104
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City | SAN FRANCISCO
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State | CA
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Zip | 94118
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Country | US
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Telephone | 415-668-5666
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Fax | 415-668-5866
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Provider Business Mailing Address
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Address Line | 3905 SACRAMENTO SUITE 104
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City | SAN FRANCISCO
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State | CA
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Zip | 94118
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Country | US
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Telephone | 415-668-5666
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Fax | 415-668-5866
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | JONATHAN FRANK NORDLICHT
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Credential | MD
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Telephone | 415-668-5666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G32963
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License Number State | CA
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