MEDICARE: DR. TATYANA G JONES PH.D.

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	103G00000X	Clinical Neuropsychologist	PSY19794	CA
2	103TC0700X	Clinical Psychologist	19794	CA
3	103T00000X	Psychologist	19794	CA
4	103TB0200X	Cognitive & Behavioral Psychologist	19794	CA
5	103TR0400X	Rehabilitation Psychologist	19794	CA
6	103TA0700X	Adult Development & Aging Psychologist	19794	CA
7	103TH0100X	Health Service Psychologist	19794	CA

General Provider Information

NPI Number	:	1740223254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA G JONES PH.D.

Provider Business Mailing Address
First Line	:	7601 IMPERIAL HWY
Second Line	:	HB 226
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-401-8192
Fax Number	:	562-401-6678

Provider Business Practice Location Address
First Line	:	7601 IMPERIAL HWY
Second Line	:	RANCHO LOS AMIGOS HB 226
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-401-8192
Fax Number	:	562-401-6678

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	02/06/2013

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