Provider Demographics
NPI:1316153232
Name:JONES, JEFFREY LANE (NAVY SFIDC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LANE
Last Name:JONES
Suffix:
Gender:M
Credentials:NAVY SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 KURDSON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5834
Mailing Address - Country:US
Mailing Address - Phone:619-479-6714
Mailing Address - Fax:
Practice Address - Street 1:3226 TARAWA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5084
Practice Address - Country:US
Practice Address - Phone:619-437-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman