Provider Demographics
NPI:1780166900
Name:MESINA, JONATHAN PAUL (RN)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAUL
Last Name:MESINA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 PENDIO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1747
Mailing Address - Country:US
Mailing Address - Phone:951-750-4419
Mailing Address - Fax:
Practice Address - Street 1:5770 RIVERSIDE DR., BLDG 601
Practice Address - Street 2:752 MEDICAL SQUADRON
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:951-655-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse