Provider Demographics
NPI:1285968131
Name:JONES, JOSHUA BENNETT (LAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BENNETT
Last Name:JONES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1801 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4915
Mailing Address - Country:US
Mailing Address - Phone:310-256-3677
Mailing Address - Fax:310-256-3677
Practice Address - Street 1:2901 WILSHIRE BLVD
Practice Address - Street 2:SUITE 233
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4901
Practice Address - Country:US
Practice Address - Phone:310-256-3677
Practice Address - Fax:310-256-3677
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist