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General NPI Number Information
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NPI Number | 1003650318
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Entity Type | Individual
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Provider Name | KYLE P. JONES PHD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1102 VALLEY CIR
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City | COSTA MESA
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State | CA
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Zip | 92627-3918
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Country | US
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Telephone | 949-244-3184
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3521
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City | COSTA MESA
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State | CA
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Zip | 92628-3521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY35099
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License Number State | CA
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