Healthcare Provider Details

I. General information

NPI: 1003576356
Provider Name (Legal Business Name): JORDAN EZBAI NARANJO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD # 2013001
NORWALK CA
90650-4328
US

IV. Provider business mailing address

4780 HAMMEL ST
LOS ANGELES CA
90022-1304
US

V. Phone/Fax

Practice location:
  • Phone: 866-869-6608
  • Fax:
Mailing address:
  • Phone: 323-392-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: