Provider Demographics
NPI:1275175762
Name:LENAHAN, JONATHAN FRANCIS
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FRANCIS
Last Name:LENAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 MURAT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2446
Mailing Address - Country:US
Mailing Address - Phone:908-433-4047
Mailing Address - Fax:
Practice Address - Street 1:1826 S COAST HWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5322
Practice Address - Country:US
Practice Address - Phone:760-453-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist