Provider Demographics
NPI:1396878377
Name:WYNN-JONES, PATRICIA A
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WYNN-JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:WYNN-JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20336 ANZA AVE
Mailing Address - Street 2:# 33
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2310
Mailing Address - Country:US
Mailing Address - Phone:310-435-3195
Mailing Address - Fax:
Practice Address - Street 1:20336 ANZA AVE
Practice Address - Street 2:# 33
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2310
Practice Address - Country:US
Practice Address - Phone:310-435-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69124207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G691240Medicaid
CAG69124OtherMEDICAL STATE LICENSE
CA000G691240Medicaid