Provider Demographics
NPI:1326392549
Name:JONES, BRADY W
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:PRESTIGE
Other - Last Name:DIAGNOSTICS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1320 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1635
Mailing Address - Country:US
Mailing Address - Phone:530-605-0810
Mailing Address - Fax:
Practice Address - Street 1:1320 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1635
Practice Address - Country:US
Practice Address - Phone:530-605-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00094163247100000X
CA4359702471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography