Provider Demographics
NPI:1053135822
Name:JONES, ANTIONETTE SHAWNTE
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:SHAWNTE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 E JACKSON AVE APT V22
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-3508
Mailing Address - Country:US
Mailing Address - Phone:714-656-7770
Mailing Address - Fax:
Practice Address - Street 1:3030 E JACKSON AVE APT V22
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-3508
Practice Address - Country:US
Practice Address - Phone:714-656-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker