Provider Demographics
NPI:1073662912
Name:CONTI, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:CONTI
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30210 RANCHO VIEJO RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1574
Mailing Address - Country:US
Mailing Address - Phone:949-493-1383
Mailing Address - Fax:949-493-1418
Practice Address - Street 1:30210 RANCHO VIEJO RD STE A
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1574
Practice Address - Country:US
Practice Address - Phone:949-493-1383
Practice Address - Fax:949-493-1418
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA71854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71854OtherMEDICAL LICENSE
CABC7216030OtherDEA LICENSE