Healthcare Provider Details

I. General information

NPI: 1174652598
Provider Name (Legal Business Name): JORDAN DUNYASHA VIX MSW/LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN DUNYASHA DUNYASHA/SHANAHAN

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349A E AVENUE K6
LANCASTER CA
93535-4548
US

IV. Provider business mailing address

2010 W AVENUE K # 389
LANCASTER CA
93536-5229
US

V. Phone/Fax

Practice location:
  • Phone: 661-974-8400
  • Fax: 661-729-2186
Mailing address:
  • Phone: 661-974-8417
  • Fax: 661-729-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: