Healthcare Provider Details

I. General information

NPI: 1790013977
Provider Name (Legal Business Name): ROBERT C. JONES M.D.MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SOQUEL AVE
SANTA CRUZ CA
95062-2309
US

IV. Provider business mailing address

515 SOQUEL AVE
SANTA CRUZ CA
95062-2309
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-2550
  • Fax: 831-426-5143
Mailing address:
  • Phone: 831-426-2550
  • Fax: 831-426-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA20300
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT C. JONES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-426-2550