Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003276155 |
---|---|
Provider Name | Teja Jones |
First Address | San Rafael, CA 94901-3507 |
Second Address | San Rafael, CA 94901-4840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2016 |
Last Update Date | 02/03/2016 |