| Doctor Name: | MR. JONATHAN FIDANI |
| NPI Number: | 1043469901 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 205 Pasadena Ave South Pasadena, CA - 910302919 |
| Business Phone Number: | 3233445541 |
| Business Fax Number: | 3233445550 |
| Mailing Address: | 1143 E Juanita Ave, GLENDORA |
| State: | CA |
| Postal Code: | 917406106 |
| Phone Number: | 6268577755 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 09/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |