Individual
JESSE JONES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RADT-1 R9201214
Contact information
Practice address
530 LOLETA LN, NOVATO, CA 94947-5210
(415) 678-6646
Mailing address
530 LOLETA LN, NOVATO, CA 94947-5210
(415) 678-6646
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
R9201214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D3861759
—
CA
Enumeration date
11/18/2015
Last updated
11/18/2015
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