Healthcare Provider Details

I. General information

NPI: 1871662981
Provider Name (Legal Business Name): JONATHAN W. JONES, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVE SUITE 205
SAN DIEGO CA
92103-2116
US

IV. Provider business mailing address

4060 4TH AVE SUITE 205
SAN DIEGO CA
92103-2116
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-1076
  • Fax: 619-260-1077
Mailing address:
  • Phone: 619-260-1076
  • Fax: 619-260-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG-40090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG-40090
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG-40090
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberG40090
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG-40090
License Number StateCA

VIII. Authorized Official

Name: JONATHAN WEYMOUTH JONES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 619-260-1076