Provider Demographics
NPI:1255303970
Name:JONES, TERESA PHYLLIS (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:PHYLLIS
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:PHYLLIS
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3333 CALIFORNIA ST.
Mailing Address - Street 2:S1-10
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1981
Mailing Address - Country:US
Mailing Address - Phone:415-885-7268
Mailing Address - Fax:
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-353-6380
Practice Address - Fax:415-353-6494
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52284363A00000X
NC104028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285682310OtherWSCA GRP NPI #
NC1285682310OtherWSCA GRP NPI #
MJ1146035OtherFEDERAL DEA
2761486AMedicare ID - Type Unspecified