MEDICARE: MR. DEMETRUS DEAN JONES PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95034830	CA

General Provider Information

NPI Number	:	1699562249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEMETRUS DEAN JONES PMHNP

Provider Business Mailing Address
First Line	:	32157 KALE LN
Second Line	:
City	:	WINCHESTER
State	:	CA
Zip	:	92596-8794
Country	:	US
Telephone Number	:	310-999-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	24910 LAS BRISAS RD STE 117
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-4035
Country	:	US
Telephone Number	:	310-999-1201
Fax Number	:

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

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/14/2026

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