Provider Demographics
NPI:1225722598
Name:SEMAAN, JONATHAN TONY (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TONY
Last Name:SEMAAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 BEYER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2099
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-662-4100
Practice Address - Street 1:4004 BEYER BLVD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2099
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-662-4100
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program