Provider Demographics
NPI:1467235309
Name:JONES, LARRY PEARSON JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:PEARSON
Last Name:JONES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1542
Mailing Address - Country:US
Mailing Address - Phone:510-274-0281
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1542
Practice Address - Country:US
Practice Address - Phone:510-274-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker