Healthcare Provider Details

I. General information

NPI: 1073291852
Provider Name (Legal Business Name): ANTHONY Y JONES M.M.P, H.E., M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7429 MAXIMILLIAN PL
ROHNERT PARK CA
94928-3648
US

IV. Provider business mailing address

7429 MAXIMILLIAN PL
ROHNERT PARK CA
94928-3648
US

V. Phone/Fax

Practice location:
  • Phone: 707-770-7421
  • Fax:
Mailing address:
  • Phone: 415-684-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number62836
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: