Provider Demographics
NPI:1588712996
Name:JONES, STANLEY L (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:805-375-8800
Mailing Address - Fax:805-375-8900
Practice Address - Street 1:3630 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-900-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA217252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A217250Medicaid
CARHL111700OtherDEPT OF HEALTH SERVICES
CARHL111700OtherDEPT OF HEALTH SERVICES
A22743Medicare UPIN
WA21725AMedicare ID - Type Unspecified