Provider Demographics
NPI:1922428184
Name:HINOJOSA, TONY JAY (CADCI-U,ICADC)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:JAY
Last Name:HINOJOSA
Suffix:
Gender:M
Credentials:CADCI-U,ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 VALLEY VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-890-6950
Mailing Address - Fax:541-479-2370
Practice Address - Street 1:806 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-890-6950
Practice Address - Fax:541-479-2370
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13490OtherCAS