Healthcare Provider Details

I. General information

NPI: 1285573121
Provider Name (Legal Business Name): MARILYN JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 TAMARACK AVE APT 127
BREA CA
92821-2535
US

IV. Provider business mailing address

825 TAMARACK AVE APT 127
BREA CA
92821-2535
US

V. Phone/Fax

Practice location:
  • Phone: 818-429-3547
  • Fax:
Mailing address:
  • Phone: 818-429-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-02358896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: