Healthcare Provider Details

I. General information

NPI: 1942832357
Provider Name (Legal Business Name): RYAN ANTHONY JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 ANTIQUE ROSE WAY
RIVERBANK CA
95367-9505
US

IV. Provider business mailing address

3425 COFFEE RD STE C2
MODESTO CA
95355-1582
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-4791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: