Healthcare Provider Details

I. General information

NPI: 1730674078
Provider Name (Legal Business Name): ROSA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST STE A
MARINA CA
93933
US

IV. Provider business mailing address

299 12TH ST STE A
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax: 831-647-7940
Mailing address:
  • Phone: 831-647-7652
  • Fax: 831-647-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: