Provider Demographics
NPI:1417424987
Name:JONES, TINA DAVROS (RD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:DAVROS
Last Name:JONES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BLACK OAK DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8491
Mailing Address - Country:US
Mailing Address - Phone:541-789-5096
Mailing Address - Fax:541-789-4674
Practice Address - Street 1:555 BLACK OAK DR STE 310
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8491
Practice Address - Country:US
Practice Address - Phone:541-789-5096
Practice Address - Fax:541-789-4674
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-000518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered