Healthcare Provider Details

I. General information

NPI: 1407644594
Provider Name (Legal Business Name): JORDAN ASHANTI RUVENEST SLAFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

IV. Provider business mailing address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax: 213-621-4155
Mailing address:
  • Phone: 213-620-5712
  • Fax: 213-621-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC18608
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: