Healthcare Provider Details

I. General information

NPI: 1851280382
Provider Name (Legal Business Name): JORDYN CAVINESS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 S SULTANA AVE
ONTARIO CA
91761-4238
US

IV. Provider business mailing address

1556 S SULTANA AVE
ONTARIO CA
91761-4238
US

V. Phone/Fax

Practice location:
  • Phone: 909-418-6923
  • Fax: 909-418-6937
Mailing address:
  • Phone: 909-418-6923
  • Fax: 909-418-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: