Healthcare Provider Details

I. General information

NPI: 1063355246
Provider Name (Legal Business Name): TAKARA L JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAGNOLIA AVE
LONG BEACH CA
90806-4521
US

IV. Provider business mailing address

2892 N BELLFLOWER BLVD UNIT 2246
LONG BEACH CA
90815-1125
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax:
Mailing address:
  • Phone: 310-912-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190085NN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: