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General NPI Number Information
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NPI Number | 1780046847
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Entity Type | Individual
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Provider Name | JONATHAN PETER GERSHENSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1380 LEAD HILL BLVD STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95661-2941
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Country | US
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Telephone | 916-535-2030
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Fax | 916-536-3061
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Provider Business Mailing Address
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Address Line | 3400 DATA DR
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 20A17270
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License Number State | CA
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