Basic Information
| Provider Information | |||||||||
| NPI: | 1134545718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAFFIE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ROBERT JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 N BRANCIFORTE AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950621010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533153141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 787 MUNRAS AVE | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316457900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2014 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.