1831441815 NPI number — JONATHAN SALUTA MD INC

Table of content: (NPI 1831441815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831441815 NPI number — JONATHAN SALUTA MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN SALUTA MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831441815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90017-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-482-2992
Provider Business Mailing Address Fax Number:
213-482-2999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 WEST 3RD STREET
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-7600
Provider Business Practice Location Address Fax Number:
213-484-7111
Provider Enumeration Date:
10/15/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALUTA
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER AND PHYSICIAN
Authorized Official Telephone Number:
213-482-2992

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A95794 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A95794 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W15810 . This is a "IND MC PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".