Jesse Jones, RADT-1 R9201214

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

R9201214 Issued in CA

Practice address

530 Loleta LN
Novato, CA 94947-5210

Phone

(415) 678-6646

NPI assigned

Nov 18, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1356715098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 LOLETA LN",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949475210",
            "telephone_number": "415-678-6646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 LOLETA LN",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949475210",
            "telephone_number": "415-678-6646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "JESSE",
        "credential": "RADT-1 R9201214",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-11-18",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "R9201214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D3861759",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Johnson, PH.D.
• Amanda Mallory Jones, RN
• Christopher Joel Jones
• Dallas Jones
• Elizabeth Jones
• Julia Brumell Jones, NURSE PRACTITIONER
• Katherine Jennie Jones, MD
• Joseph a Habis MD
• Cecilia Jovel
• Christine Soohee Juhn, DDS

• Substance Abuse Rehabilitation Facility in Novato, CA
• Providers in Novato, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.