MEDICARE: JON CONTI M.D

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
1	208000000X	Pediatrics Physician	A71854	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A71854	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1073662912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON CONTI M.D

Provider Business Mailing Address
First Line	:	30210 RANCHO VIEJO RD STE A
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1574
Country	:	US
Telephone Number	:	949-493-1383
Fax Number	:	949-493-1418

Provider Business Practice Location Address
First Line	:	30210 RANCHO VIEJO RD STE A
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1574
Country	:	US
Telephone Number	:	949-493-1383
Fax Number	:	949-493-1418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/07/2023

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Directions to “ JON CONTI M.D” Practice Location

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