Healthcare Provider Details

I. General information

NPI: 1457286429
Provider Name (Legal Business Name): JORDAN SWAINSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 NUTMEG ST
SAN DIEGO CA
92103-6201
US

IV. Provider business mailing address

1390 SANTA ALICIA AVE APT 9309
CHULA VISTA CA
91913-1860
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-2097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: