Healthcare Provider Details

I. General information

NPI: 1275784043
Provider Name (Legal Business Name): JORDAN D SYBRANDT MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S. MAGNOLIA AVE STE 302
EL CAJON CA
92020
US

IV. Provider business mailing address

9465 FARNHAM ST SUITE 207
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-5434
  • Fax: 619-312-6741
Mailing address:
  • Phone: 858-573-2600
  • Fax: 619-425-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: