Provider Demographics
NPI:1720744220
Name:ALYADAGO, JONES
Entity Type:Individual
Prefix:
First Name:JONES
Middle Name:
Last Name:ALYADAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 N MAGNOLIA AVE APT M8
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1722
Mailing Address - Country:US
Mailing Address - Phone:619-922-9002
Mailing Address - Fax:
Practice Address - Street 1:9730 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3808
Practice Address - Country:US
Practice Address - Phone:619-448-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist