Healthcare Provider Details

I. General information

NPI: 1811185705
Provider Name (Legal Business Name): JORDAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 HOSPITAL DR STE G
SACRAMENTO CA
95823-5406
US

IV. Provider business mailing address

7600 HOSPITAL DR STE G
SACRAMENTO CA
95823-5406
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-2021
  • Fax: 916-525-2065
Mailing address:
  • Phone: 916-525-2021
  • Fax: 916-525-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA53618
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA53618
License Number StateCA

VIII. Authorized Official

Name: DR. REBECCA JORDAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-525-2021