Healthcare Provider Details

I. General information

NPI: 1063321388
Provider Name (Legal Business Name): JORDAN ALEXANDRA LYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD STE 300
LOS ANGELES CA
90010-1439
US

IV. Provider business mailing address

10853 ROSE AVE APT 69
LOS ANGELES CA
90034-5397
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: