Healthcare Provider Details

I. General information

NPI: 1801355136
Provider Name (Legal Business Name): JORDAN A HASTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE ST
OAKLAND CA
94607-2608
US

IV. Provider business mailing address

473 JEAN ST APT 210
OAKLAND CA
94610-2684
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax:
Mailing address:
  • Phone: 302-690-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA187557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: