Basic Information
| Provider Information | |||||||||
| NPI: | 1982686333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARON | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ALEC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 E 17TH ST | ||||||||
| Address2: | STE W248 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145475151 | ||||||||
| FaxNumber: | 7145412016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 E 17TH ST | ||||||||
| Address2: | STE W248 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145475151 | ||||||||
| FaxNumber: | 7145412016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A82045 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.