Provider Demographics
NPI:1699836981
Name:PHILIP L. OLKIN, M.D. AND C. RAY JONES, M.D.
Entity type:Organization
Organization Name:PHILIP L. OLKIN, M.D. AND C. RAY JONES, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-725-3318
Mailing Address - Street 1:3302 RENNER DR
Mailing Address - Street 2:PO BOX 835
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3120
Mailing Address - Country:US
Mailing Address - Phone:707-725-3318
Mailing Address - Fax:707-725-9396
Practice Address - Street 1:3302 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3120
Practice Address - Country:US
Practice Address - Phone:707-725-3318
Practice Address - Fax:707-725-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C429870Medicaid
CARHM53808FMedicaid
CAG32253OtherDR OLKIN LIC #
CAC49287OtherDR JONES LIC #
CA00G322530Medicaid
CA00G322530Medicare ID - Type UnspecifiedDR. OLKIN #
CA55-3808Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC ID #
CAG32253OtherDR OLKIN LIC #
CA00G322530Medicaid
CARHM53808FMedicaid