Individual
JONATHAN NISSANOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15525 POMERADO RD STE E6, POWAY, CA 92064-2427
(858) 451-2280
(858) 451-2006
Mailing address
PO BOX 502530, SAN DIEGO, CA 92150-2530
(858) 451-2280
(858) 451-2006
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G82348
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G823480
—
CA
Enumeration date
07/31/2006
Last updated
07/08/2007
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