Healthcare Provider Details

I. General information

NPI: 1306581780
Provider Name (Legal Business Name): STEPHANIE LAUREL JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7041
  • Fax:
Mailing address:
  • Phone: 916-734-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA209489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: