Provider Demographics
NPI:1619084969
Name:UNATIN, JEROME HAROLD I (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:HAROLD
Last Name:UNATIN
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 CRENSHAW BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5233
Mailing Address - Country:US
Mailing Address - Phone:310-200-8036
Mailing Address - Fax:
Practice Address - Street 1:23560 CRENSHAW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5233
Practice Address - Country:US
Practice Address - Phone:310-784-2355
Practice Address - Fax:310-517-1817
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13334207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02606ZOtherBLUE SHIELD ZZ NUMBER
CAWG13334EMedicare ID - Type Unspecified
CAZZZ02606ZOtherBLUE SHIELD ZZ NUMBER