Provider Demographics
NPI:1699128918
Name:JAYNES, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9616 SHIMIZU RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7243
Mailing Address - Country:US
Mailing Address - Phone:714-273-4414
Mailing Address - Fax:
Practice Address - Street 1:9616 SHIMIZU RIVER CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7243
Practice Address - Country:US
Practice Address - Phone:714-273-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710415163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency