Healthcare Provider Details

I. General information

NPI: 1689304537
Provider Name (Legal Business Name): STACEY ANN JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W TOKAY ST
LODI CA
95240-3965
US

IV. Provider business mailing address

3123 INDEPENDENCE DR
LIVERMORE CA
94551-7595
US

V. Phone/Fax

Practice location:
  • Phone: 209-319-7550
  • Fax:
Mailing address:
  • Phone: 209-319-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: