Provider Demographics
NPI:1790854578
Name:VRBAN, JONATHAN MICHAEL (NP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:VRBAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:MICHAEL
Other - Last Name:VRBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1980 VALLEJO ST
Mailing Address - Street 2:NINTH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4962
Mailing Address - Country:US
Mailing Address - Phone:415-563-1440
Mailing Address - Fax:415-563-3216
Practice Address - Street 1:2425 GEARY BLVD
Practice Address - Street 2:EMPLOYEE HEALTH
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-833-6355
Practice Address - Fax:415-833-6471
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 11632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP31505 ZZZ20180ZMedicare UPIN