Provider Demographics
NPI:1114307535
Name:JONES, ROBERTA E
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:E
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 W 36TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-4504
Mailing Address - Country:US
Mailing Address - Phone:323-731-3534
Mailing Address - Fax:323-731-5618
Practice Address - Street 1:1665 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1533
Practice Address - Country:US
Practice Address - Phone:323-731-3534
Practice Address - Fax:323-731-5618
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator