Healthcare Provider Details

I. General information

NPI: 1730471152
Provider Name (Legal Business Name): ALLISSEN C JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISSEN C JONES

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 01/06/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N AVENUE 66
LOS ANGELES CA
90042-1508
US

IV. Provider business mailing address

18282 LAKEPOINTE DR
RIVERSIDE CA
92503-0253
US

V. Phone/Fax

Practice location:
  • Phone: 626-517-2368
  • Fax:
Mailing address:
  • Phone: 949-424-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: