Provider Demographics
NPI:1679799456
Name:JONES, NOLAN C
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NOLAN
Other - Middle Name:
Other - Last Name:JONES MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-290-3900
Mailing Address - Fax:323-294-7586
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-290-3900
Practice Address - Fax:323-294-7586
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30400207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26101Medicare UPIN