Individual
MR. JONATHAN M LICHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4033 3RD AVE, SUITE 206, SAN DIEGO, CA 92103-2117
(619) 294-9292
Mailing address
4033 3RD AVE, SUITE 206, SAN DIEGO, CA 92103-2117
(619) 294-9292
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G43892
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G438921
—
CA
Enumeration date
01/19/2006
Last updated
01/11/2010
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