MEDICARE: KIMBERLY JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1265840912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JONES

Provider Business Mailing Address
First Line	:	2360 1/2 W WASHINGTON BLVD
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1424
Country	:	US
Telephone Number	:	323-474-9033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 1/2 W WASHINGTON BLVD
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1424
Country	:	US
Telephone Number	:	323-474-9033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	07/14/2015

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Directions to “ KIMBERLY JONES ” Practice Location

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