Healthcare Provider Details

I. General information

NPI: 1669911921
Provider Name (Legal Business Name): CHRISTOPHER JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6932 TYNE CT
DUBLIN CA
94568-2146
US

IV. Provider business mailing address

6932 TYNE CT
DUBLIN CA
94568-2146
US

V. Phone/Fax

Practice location:
  • Phone: 925-819-4078
  • Fax: 925-918-4299
Mailing address:
  • Phone: 925-819-4078
  • Fax: 925-918-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: