Provider Demographics
NPI:1730348053
Name:ABELSON, JONATHAN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALAN
Last Name:ABELSON
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 1:2230 LYNN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2230 LYNN RD STE 103
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1958
Practice Address - Country:US
Practice Address - Phone:805-496-4111
Practice Address - Fax:805-496-2861
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA1053222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730348053Medicaid
CAGH196ZMedicare PIN