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General NPI Number Information
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NPI Number | 1700591351
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Entity Type | Individual
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Provider Name | JONATHAN KORBELAK
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Gender | Male
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 762 GRISWOLD AVE
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2105
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Country | US
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Telephone | 747-500-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 10458 PETIT AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-7313
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Country | US
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Telephone | 626-679-4080
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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