Provider Demographics
NPI:1124395116
Name:MASAYON, JONATHAN BLIC ARPON (LVN)
Entity type:Individual
Prefix:MR
First Name:JONATHAN BLIC
Middle Name:ARPON
Last Name:MASAYON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 LAS VEGAS AVE. APT. 9
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2139
Mailing Address - Country:US
Mailing Address - Phone:626-274-1431
Mailing Address - Fax:
Practice Address - Street 1:2018 LAS VEGAS AVE APT 9
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2735
Practice Address - Country:US
Practice Address - Phone:626-274-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN242379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse