Provider Demographics
NPI:1730942186
Name:JONES, WENDELL RASHAD
Entity type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:RASHAD
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 STEVENS CREEK BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4607
Mailing Address - Country:US
Mailing Address - Phone:831-231-0966
Mailing Address - Fax:
Practice Address - Street 1:2858 STEVENS CREEK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4607
Practice Address - Country:US
Practice Address - Phone:831-231-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17984225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist