Healthcare Provider Details

I. General information

NPI: 1396484291
Provider Name (Legal Business Name): JORDYN J-M HARTLEY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORDAN J-M HARTLEY

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY STE 220
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

3646 WEST ST
OAKLAND CA
94608-3921
US

V. Phone/Fax

Practice location:
  • Phone: 628-250-7500
  • Fax:
Mailing address:
  • Phone: 831-854-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: