Provider Demographics
NPI:1861866741
Name:JONATHAN E SHAYWITZ MD INC
Entity Type:Organization
Organization Name:JONATHAN E SHAYWITZ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAYWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-697-6865
Mailing Address - Street 1:24310 MOULTON PKWY
Mailing Address - Street 2:SUITE O #563
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:949-680-4500
Mailing Address - Fax:951-600-7626
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6773
Practice Address - Country:US
Practice Address - Phone:949-499-1311
Practice Address - Fax:951-600-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty