Basic Information
| Provider Information | |||||||||
| NPI: | 1154436533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E PALOMAR ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919131800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193973165 | ||||||||
| FaxNumber: | 6193973386 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E PALOMAR ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919131800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193973165 | ||||||||
| FaxNumber: | 6193973386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E4133 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000E41330 | 05 | CA | MEDICAID |