Provider Demographics
NPI:1154551893
Name:TATOMER, JONATHAN REEVES (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:REEVES
Last Name:TATOMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 PRESTON WAY
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2100
Mailing Address - Country:US
Mailing Address - Phone:559-300-9943
Mailing Address - Fax:
Practice Address - Street 1:1837 PRESTON WAY
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2100
Practice Address - Country:US
Practice Address - Phone:559-300-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG219032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry