Healthcare Provider Details

I. General information

NPI: 1598602534
Provider Name (Legal Business Name): JORDAN S HEDGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 GENEIVE ST
CAMARILLO CA
93010-7817
US

IV. Provider business mailing address

197 GENEIVE ST
CAMARILLO CA
93010-7817
US

V. Phone/Fax

Practice location:
  • Phone: 805-949-8287
  • Fax:
Mailing address:
  • Phone: 805-732-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: