Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A132204 | CA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | A132204 | CA |
NPI | 1487097929 |
---|---|
Provider Name | Loni D Jay |
First Address | Sacramento, CA 95865-5228 |
Second Address | Jackson, CA 95642-2154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 14/01/2021 |