Healthcare Provider Details

I. General information

NPI: 1275468944
Provider Name (Legal Business Name): BETHENY JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GOLD CREST CT
PITTSBURG CA
94565-6500
US

IV. Provider business mailing address

PO BOX 1271
PITTSBURG CA
94565-0127
US

V. Phone/Fax

Practice location:
  • Phone: 925-318-0845
  • Fax: 925-318-0845
Mailing address:
  • Phone: 925-318-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: