Healthcare Provider Details

I. General information

NPI: 1730686171
Provider Name (Legal Business Name): MIARAH JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E MONTE VISTA AVE
VACAVILLE CA
95688-3009
US

IV. Provider business mailing address

2550 HILBORN RD APT 30
FAIRFIELD CA
94534-1084
US

V. Phone/Fax

Practice location:
  • Phone: 707-469-4540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: