Healthcare Provider Details

I. General information

NPI: 1922425487
Provider Name (Legal Business Name): PATRICK JORDAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HARDEN PKWY STE 101
SALINAS CA
93906
US

IV. Provider business mailing address

110 HARDEN PKWY STE 101
SALINAS CA
93906-5257
US

V. Phone/Fax

Practice location:
  • Phone: 831-443-6050
  • Fax:
Mailing address:
  • Phone: 831-443-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: