Basic Information
| Provider Information | |||||||||
| NPI: | 1861866741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JONATHAN E SHAYWITZ MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24310 MOULTON PKWY | ||||||||
| Address2: | SUITE O #563 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926373306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496804500 | ||||||||
| FaxNumber: | 9516007626 | ||||||||
| Practice Location | |||||||||
| Address1: | 31872 COAST HWY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926516773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494991311 | ||||||||
| FaxNumber: | 9516007626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2015 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHAYWITZ | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3106976865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.