Provider Demographics
NPI:1619048840
Name:JAMILI, JONATHAN AUGUSTINE CAPURAS (PHN)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN AUGUSTINE
Middle Name:CAPURAS
Last Name:JAMILI
Suffix:
Gender:M
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-567-6238
Mailing Address - Fax:
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-480-4665
Practice Address - Fax:714-568-4933
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71086364SC1501X
CA650810163WC1500X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No251S00000XAgenciesCommunity/Behavioral Health