Provider Demographics
NPI:1578508743
Name:JONES, RANDY F (PA)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:F
Last Name:JONES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 GROSSMONT CENTER DRIVE SUITE 200
Mailing Address - Street 2:GROSSMONT FAMILY MEDICAL GROUP
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-644-6500
Mailing Address - Fax:
Practice Address - Street 1:5525 GROSSMONT CENTER DRIVE SUITE 200
Practice Address - Street 2:GROSSMONT FAMILY MEDICAL GROUP
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-644-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222833Medicare PIN
CAQ65695Medicare UPIN