Provider Demographics
NPI:1104366822
Name:ALATORRE, JONATHAN (CCAPP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ALATORRE
Suffix:
Gender:M
Credentials:CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EUCLID AVE SUITE 40-50
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3617
Mailing Address - Country:US
Mailing Address - Phone:619-795-7232
Mailing Address - Fax:619-795-7256
Practice Address - Street 1:220 EUCLID AVE STE 40&50
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3644
Practice Address - Country:US
Practice Address - Phone:619-795-7232
Practice Address - Fax:619-795-7256
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-A1303271403101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)