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General NPI Number Information
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NPI Number | 1710668728
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Entity Type | Individual
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Provider Name | JONAH GABRIEL MARANON PTA
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Gender | Male
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 4626 WILLOW RD
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City | PLEASANTON
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State | CA
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Zip | 94588-8517
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Country | US
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Telephone | 925-463-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 NORMANDY CIR
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City | LIVERMORE
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State | CA
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Zip | 94550-8226
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Country | US
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Telephone | 925-337-6284
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 52666
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License Number State | CA
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