Provider Demographics
NPI:1578289591
Name:JONES, ANATASHA MAREE
Entity Type:Individual
Prefix:
First Name:ANATASHA
Middle Name:MAREE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 VINEYARD AVE APT 700H
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3378
Mailing Address - Country:US
Mailing Address - Phone:678-313-4327
Mailing Address - Fax:
Practice Address - Street 1:9333 BASE LINE RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1350
Practice Address - Country:US
Practice Address - Phone:909-755-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty