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NPI Code Detail

MEDICARE: MR. JONATHAN HOWARD BAZAES

MEDICARE: MR. JONATHAN HOWARD BAZAES
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
1390200000XStudent in an Organized Health Care Education/Training Program
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1639616394
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN HOWARD BAZAES
Provider Business Mailing Address
First Line : 10200 SEPULVEDA BLVD STE 170
Second Line :
City : MISSION HILLS
State : CA
Zip : 91345-3322
Country : US
Telephone Number : 818-895-9707
Fax Number :
Provider Business Practice Location Address
First Line : 10200 SEPULVEDA BLVD STE 170
Second Line :
City : MISSION HILLS
State : CA
Zip : 91345-3322
Country : US
Telephone Number : 818-895-9707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2017
Last Update Date : 02/02/2024

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