Basic Information
| Provider Information | |||||||||
| NPI: | 1841424728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 S LEMON AVE STE 1450 | ||||||||
| Address2: | |||||||||
| City: | WALNUT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917892706 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2311 LOVERIDGE RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A-1579-10 | NM | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208D00000X | 20A12657 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | A-1579-10 | NM | N | Allopathic & Osteopathic Physicians | General Practice | 2084P0800X | 20A12657 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.