Provider Demographics
NPI:1184881351
Name:STONE, JESS C (MD)
Entity type:Individual
Prefix:DR
First Name:JESS
Middle Name:C
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11583 C AVE
Mailing Address - Street 2:PLACER COUNTY COMMUNITY CLINIC
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2703
Mailing Address - Country:US
Mailing Address - Phone:530-889-7215
Mailing Address - Fax:530-889-7280
Practice Address - Street 1:11583 C AVE
Practice Address - Street 2:PLACER COUNTY COMMUNITY CLINIC
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2703
Practice Address - Country:US
Practice Address - Phone:530-889-7215
Practice Address - Fax:530-889-7280
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26846172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker