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General NPI Number Information
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NPI Number | 1891592473
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Entity Type | Individual
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Provider Name | JONATHAN DAVID SEMILLO ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 6000 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-2605
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Country | US
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Telephone | 916-278-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 10424 GRASS VALLEY CT
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City | STOCKTON
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State | CA
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Zip | 95209-4549
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Country | US
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Telephone | 209-938-7131
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-10256506
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License Number State | OR
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