Provider Demographics
NPI:1134182041
Name:JONES, FAY (LAC)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4447
Mailing Address - Country:US
Mailing Address - Phone:818-881-1611
Mailing Address - Fax:
Practice Address - Street 1:20914 NORDHOFF ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5934
Practice Address - Country:US
Practice Address - Phone:818-718-9700
Practice Address - Fax:818-718-9707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9095171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist