Provider Demographics
NPI:1811531502
Name:ALARCON-ANAYA, JONATHAN ERNESTO
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ERNESTO
Last Name:ALARCON-ANAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5637
Mailing Address - Country:US
Mailing Address - Phone:541-779-2003
Mailing Address - Fax:
Practice Address - Street 1:3512 LONE PINE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5637
Practice Address - Country:US
Practice Address - Phone:541-779-2003
Practice Address - Fax:541-772-0147
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA241902374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR323OtherDADS PROGRAM ON TRACK ROGUE VALLEY