Provider Demographics
NPI:1558943811
Name:JESSICA JONES NUTRITION, LLC
Entity type:Organization
Organization Name:JESSICA JONES NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDE
Authorized Official - Phone:415-572-1444
Mailing Address - Street 1:5116 FRESNO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-5413
Mailing Address - Country:US
Mailing Address - Phone:415-572-1444
Mailing Address - Fax:
Practice Address - Street 1:5116 FRESNO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-5413
Practice Address - Country:US
Practice Address - Phone:510-423-3636
Practice Address - Fax:415-275-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427533744Medicaid
CA1346408655Medicaid
CA1114337383Medicaid