Provider Demographics
NPI:1720803679
Name:MONITZ, JONATHAN CLAYTON (LAC, MTOM)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CLAYTON
Last Name:MONITZ
Suffix:
Gender:M
Credentials:LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 HOLLYWOOD BLVD STE C189
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3480
Mailing Address - Country:US
Mailing Address - Phone:818-451-3461
Mailing Address - Fax:
Practice Address - Street 1:12135 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3832
Practice Address - Country:US
Practice Address - Phone:818-674-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist