Healthcare Provider Details

I. General information

NPI: 1922945716
Provider Name (Legal Business Name): ERIC LAMARR JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 WOODROW AVE
VALLEJO CA
94591-7429
US

IV. Provider business mailing address

427 WOODROW AVE
VALLEJO CA
94591-7429
US

V. Phone/Fax

Practice location:
  • Phone: 707-655-0377
  • Fax:
Mailing address:
  • Phone: 707-655-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberA2013218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: