Provider Demographics
NPI:1275726929
Name:JONES, CHARLES B (CP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:JONES
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4417
Mailing Address - Country:US
Mailing Address - Phone:562-426-5531
Mailing Address - Fax:562-426-6773
Practice Address - Street 1:2268 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4417
Practice Address - Country:US
Practice Address - Phone:562-426-5531
Practice Address - Fax:562-426-6773
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0014030Medicaid