Provider Demographics
NPI:1679846547
Name:JON J. ATIGA M.D., INC.
Entity Type:Organization
Organization Name:JON J. ATIGA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-699-6115
Mailing Address - Street 1:27699 JEFFERSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2697
Mailing Address - Country:US
Mailing Address - Phone:951-699-6115
Mailing Address - Fax:951-699-6375
Practice Address - Street 1:27699 JEFFERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2697
Practice Address - Country:US
Practice Address - Phone:951-699-6115
Practice Address - Fax:951-699-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA437022080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE82779Medicare UPIN