Provider Demographics
NPI:1518449354
Name:GASPAR, JON CHRSITOPHER SANA
Entity Type:Individual
Prefix:
First Name:JON CHRSITOPHER
Middle Name:SANA
Last Name:GASPAR
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 1:10429 CHERISE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4404
Mailing Address - Country:US
Mailing Address - Phone:765-409-8878
Mailing Address - Fax:
Practice Address - Street 1:1517 KNICKERBOCKER DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3119
Practice Address - Country:US
Practice Address - Phone:209-957-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385552251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics