Provider Demographics
NPI:1457789430
Name:JONES, DONOVAN (SFIDC)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 W CROWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5164
Mailing Address - Country:US
Mailing Address - Phone:559-786-3070
Mailing Address - Fax:
Practice Address - Street 1:5948 W CROWLEY AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5164
Practice Address - Country:US
Practice Address - Phone:559-786-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman