Healthcare Provider Details

I. General information

NPI: 1841104122
Provider Name (Legal Business Name): JORDAN ALTSHUL APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W CREST ST STE 205
ESCONDIDO CA
92025-1736
US

IV. Provider business mailing address

7933 SITIO ABRIDOR
CARLSBAD CA
92009-2913
US

V. Phone/Fax

Practice location:
  • Phone: 619-630-7793
  • Fax:
Mailing address:
  • Phone: 760-585-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: