Provider Demographics
NPI:1972035509
Name:JONES, JEREMY JACQUELINE
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JACQUELINE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 SEA KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3201
Mailing Address - Country:US
Mailing Address - Phone:858-750-0401
Mailing Address - Fax:
Practice Address - Street 1:2901 STADIUM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76129-0006
Practice Address - Country:US
Practice Address - Phone:858-750-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program