=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467566158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE JENNIE JONES MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505A SAN MARIN DR STE 260
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-898-5437
-----------------------------------------------------
Fax | 415-898-1698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 S ELISEO DR STE 1A
-----------------------------------------------------
City | GREENBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-461-5436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G40047
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------