Healthcare Provider Details

I. General information

NPI: 1609323070
Provider Name (Legal Business Name): LAILA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR STE 226
SAN DIEGO CA
92123-1767
US

IV. Provider business mailing address

PO BOX 270653
SAN DIEGO CA
92198-2653
US

V. Phone/Fax

Practice location:
  • Phone: 858-477-8170
  • Fax:
Mailing address:
  • Phone: 203-292-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015752
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6703
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: