MEDICARE: CAMERON JORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861202194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON JORDAN

Provider Business Mailing Address
First Line	:	2712 PASEO DEL PALACIO
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 PASEO DEL PALACIO
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5073
Country	:	US
Telephone Number	:	909-263-4755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	01/09/2025

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Directions to “ CAMERON JORDAN ” Practice Location

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