MEDICARE: MAYA ISABEL 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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881414878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA ISABEL JONES

Provider Business Mailing Address
First Line	:	39 HOLLYWOOD AVE
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 HOLLYWOOD AVE
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3113
Country	:	US
Telephone Number	:	908-499-9021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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