Provider Demographics
NPI:1073628434
Name:NEAL, JONATHAN (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 CRENSHAW BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3333
Mailing Address - Country:US
Mailing Address - Phone:310-618-9200
Mailing Address - Fax:310-618-1241
Practice Address - Street 1:2382 CRENSHAW BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3333
Practice Address - Country:US
Practice Address - Phone:310-618-9200
Practice Address - Fax:310-618-1241
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99734Medicare UPIN
W20A8034EMedicare ID - Type UnspecifiedMEDICARE PART B PPIN