Provider Demographics
NPI:1588021810
Name:WARE, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WARE
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 1:2925 E 7TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4858
Mailing Address - Country:US
Mailing Address - Phone:310-866-0834
Mailing Address - Fax:
Practice Address - Street 1:295 REDONDO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5900
Practice Address - Country:US
Practice Address - Phone:562-704-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist