Provider Demographics
NPI:1588951271
Name:JONES, JACOB (DPM)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2111
Mailing Address - Country:US
Mailing Address - Phone:714-771-4191
Mailing Address - Fax:714-771-2731
Practice Address - Street 1:845 W LA VETA AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-997-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5137213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235008Medicare UPIN
CACB213662Medicare PIN