Healthcare Provider Details

I. General information

NPI: 1235377706
Provider Name (Legal Business Name): MAKEDA R JONES AEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 W DAHL LN
SANTA ANA CA
92704-3110
US

IV. Provider business mailing address

2614 W DAHL LN
SANTA ANA CA
92704-3110
US

V. Phone/Fax

Practice location:
  • Phone: 310-350-4046
  • Fax:
Mailing address:
  • Phone: 310-350-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number84981
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number1388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: