Provider Demographics
NPI:1356591697
Name:JONES, JENNIFER JUNE (NA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUNE
Last Name:JONES
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31760 CASINO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4561
Mailing Address - Country:US
Mailing Address - Phone:951-471-4600
Mailing Address - Fax:
Practice Address - Street 1:31760 CASINO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4561
Practice Address - Country:US
Practice Address - Phone:951-471-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVYTNMPZHDLJWUKQC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA223581OtherEMPLOYEE NUMBER
CA1356591697Medicaid