Healthcare Provider Details

I. General information

NPI: 1386024008
Provider Name (Legal Business Name): ALEJANDRA JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-3464
US

IV. Provider business mailing address

542 N SHELTON ST APT 1
BURBANK CA
91506-1852
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 520-307-1515
  • Fax: 818-848-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: