Provider Demographics
NPI:1568472264
Name:JONES, MARVIN DEAN (NP/PA-C)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:DEAN
Last Name:JONES
Suffix:
Gender:M
Credentials:NP/PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:559-624-5128
Mailing Address - Fax:559-625-7576
Practice Address - Street 1:400 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6237
Practice Address - Country:US
Practice Address - Phone:559-624-5128
Practice Address - Fax:559-625-7576
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP21819Medicare UPIN