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NPI Code Detail

MEDICARE: MR. JONATHAN SINCLAIR NETTLES

MEDICARE: MR. JONATHAN SINCLAIR NETTLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorB9206616CA

General Provider Information

NPI Number : 1013051523
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN SINCLAIR NETTLES
Provider Business Mailing Address
First Line : 1501 HUGHES WAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-1876
Country : US
Telephone Number : 310-221-6336
Fax Number :
Provider Business Practice Location Address
First Line : 1501 HUGHES WAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-1876
Country : US
Telephone Number : 310-221-6336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/08/2007

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Directions to “ MR. JONATHAN SINCLAIR NETTLES ” Practice Location

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