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NPI Code Detail

MEDICARE: WANDA K JONES

MEDICARE: WANDA K JONES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1063614154
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANDA K JONES
Provider Business Mailing Address
First Line : 1992 CLUSTER PINE RD
Second Line :
City : COLTON
State : CA
Zip : 92324-7403
Country : US
Telephone Number : 951-317-8220
Fax Number :
Provider Business Practice Location Address
First Line : 558 N TOWNE AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-4826
Country : US
Telephone Number : 909-622-2273
Fax Number : 909-622-6334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 07/08/2007

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