Provider Demographics
NPI:1104857572
Name:CRESS, JONATHAN HART (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HART
Last Name:CRESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SOQUEL AVE., STE.B
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2321
Mailing Address - Country:US
Mailing Address - Phone:831-427-1930
Mailing Address - Fax:
Practice Address - Street 1:526 SOQUEL AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2321
Practice Address - Country:US
Practice Address - Phone:831-427-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24390173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23959Medicare UPIN
CA00A243900Medicare PIN