Provider Demographics
NPI:1649012311
Name:JONES, JAELA ANESIA
Entity type:Individual
Prefix:
First Name:JAELA
Middle Name:ANESIA
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 1:19186 ABBY AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1737
Mailing Address - Country:US
Mailing Address - Phone:216-609-2191
Mailing Address - Fax:
Practice Address - Street 1:19186 ABBY AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1737
Practice Address - Country:US
Practice Address - Phone:216-609-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUA534404172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver