Basic Information
| Provider Information | |||||||||
| NPI: | 1932337029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | JAMILLA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 WONDER WORLD DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123963911 | ||||||||
| FaxNumber: | 5123530807 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 WONDER WORLD DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123963911 | ||||||||
| FaxNumber: | 5123530807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P6282 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 327868103 | 05 | TX | MEDICAID | 317650YMG2 | 01 | MEDICARE | OTHER | P01880939 | 01 | RR MEDICARE | OTHER |