=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376769687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAKIYA LYNETTE JONES D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1037 BEAUMONT AVE
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-769-7797
-----------------------------------------------------
Fax | 951-769-5585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4418 ANGELES VISTA BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90043-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 51774
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------