Provider Demographics
NPI:1346588605
Name:VAKNIN, JONATHAN (SA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:VAKNIN
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 S HIGLEY RD
Mailing Address - Street 2:SUITE# 114-304
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-435-1931
Mailing Address - Fax:
Practice Address - Street 1:3317 S HIGLEY RD
Practice Address - Street 2:SUITE# 114-304
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-5436
Practice Address - Country:US
Practice Address - Phone:480-435-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant