Provider Demographics
NPI:1720374192
Name:JONES, CARRIE REGNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:REGNOLDS
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MARINA BAY PKWY
Mailing Address - Street 2:BLDG.P, THIRD FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:510-620-5652
Mailing Address - Fax:
Practice Address - Street 1:850 MARINA BAY PKWY
Practice Address - Street 2:BLDG.P, THIRD FLOOR
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804
Practice Address - Country:US
Practice Address - Phone:510-620-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA766872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76687OtherCALIFORNIA MEDICAL LICENSE