Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | BOC2000018524 | CA |
Y | 213ES0000X | Sports Medicine | BOC2000018524 | CA |
NPI | 1093387052 |
---|---|
Provider Name | Learie N Jones JR. |
First Address | Walnut Creek, CA 94596-5510 |
Second Address | Moraga, CA 94575-2715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2021 |
Last Update Date | 10/07/2021 |