Provider Demographics
NPI:1740749126
Name:TOBAR MORALES, JONATHAN EDILSON (MS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDILSON
Last Name:TOBAR MORALES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13079 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2575
Mailing Address - Country:US
Mailing Address - Phone:818-206-3353
Mailing Address - Fax:
Practice Address - Street 1:13079 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2575
Practice Address - Country:US
Practice Address - Phone:818-206-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant