Healthcare Provider Details

I. General information

NPI: 1982533378
Provider Name (Legal Business Name): JORDAN ALEXANDRA VALLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AVOCADO AVE
PERRIS CA
92571-2605
US

IV. Provider business mailing address

126 AVOCADO AVE
PERRIS CA
92571-2605
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-7212
  • Fax:
Mailing address:
  • Phone: 951-943-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95286127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: