Provider Demographics
NPI:1730471152
Name:JONES, ALLISSEN C
Entity Type:Individual
Prefix:
First Name:ALLISSEN
Middle Name:C
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISSEN
Other - Middle Name:C
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25544 RED HAWK RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-3159
Mailing Address - Country:US
Mailing Address - Phone:951-956-4094
Mailing Address - Fax:
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:SUITE C236
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-653-0819
Practice Address - Fax:951-656-2614
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA36047167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator