Provider Demographics
NPI:1821067687
Name:JONES, NATHANIEL MARK SR (IDC)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:MARK
Last Name:JONES
Suffix:SR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1801 N VENTURA RD
Mailing Address - Street 2:APT 78
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3357
Mailing Address - Country:US
Mailing Address - Phone:805-485-8701
Mailing Address - Fax:805-989-3936
Practice Address - Street 1:ONE DISPENSARY RD
Practice Address - Street 2:BLDG 5
Practice Address - City:PT MUGU NAWC
Practice Address - State:CA
Practice Address - Zip Code:93042-0001
Practice Address - Country:US
Practice Address - Phone:805-989-8264
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman