Healthcare Provider Details

I. General information

NPI: 1508609306
Provider Name (Legal Business Name): JORDYN JANAI CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 ADELINE ST
BERKELEY CA
94703-2439
US

IV. Provider business mailing address

2497 GOLDEN GATE AVE # 520
SAN FRANCISCO CA
94118-4315
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-5249
  • Fax:
Mailing address:
  • Phone: 469-203-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: