Healthcare Provider Details

I. General information

NPI: 1538806039
Provider Name (Legal Business Name): DR. JORDAN PATRICK JORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 150
MISSION VIEJO CA
92691-8018
US

IV. Provider business mailing address

1 GENESYS PKWY
GRAND BLANC MI
48439-8065
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351049761
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA210078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: