1083748032 NPI number — EDITH A. JONES-POLAND MD PROFESSIONAL CORP

Table of content: (NPI 1083748032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083748032 NPI number — EDITH A. JONES-POLAND MD PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDITH A. JONES-POLAND MD PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083748032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56925 YUCCA TRL
Provider Second Line Business Mailing Address:
NUMBER 232
Provider Business Mailing Address City Name:
YUCCA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92284-7913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-401-2502
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56925 YUCCA TRL
Provider Second Line Business Practice Location Address:
NUMBER 232
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-7913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-401-2502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES-POLAND
Authorized Official First Name:
EDITH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-401-2502

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A76482 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com