Healthcare Provider Details

I. General information

NPI: 1669392957
Provider Name (Legal Business Name): MATTEA DIANE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 72ND AVE
OAKLAND CA
94605-2510
US

IV. Provider business mailing address

3322 72ND AVE
OAKLAND CA
94605-2510
US

V. Phone/Fax

Practice location:
  • Phone: 816-668-6558
  • Fax:
Mailing address:
  • Phone: 816-668-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: