Provider Demographics
NPI:1831167212
Name:ZUNIGA, JONATHAN MEDENILLA (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MEDENILLA
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3847 TEAYS VALLEY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9622
Mailing Address - Country:US
Mailing Address - Phone:304-760-8904
Mailing Address - Fax:304-760-8913
Practice Address - Street 1:3847 TEAYS VALLEY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9622
Practice Address - Country:US
Practice Address - Phone:304-760-8904
Practice Address - Fax:304-760-8913
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20402207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1805869000Medicaid
4041282Medicare ID - Type Unspecified
G41744Medicare UPIN