Healthcare Provider Details

I. General information

NPI: 1316872278
Provider Name (Legal Business Name): JORDAN LUPDAG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 COMPLEX DR STE F
SAN DIEGO CA
92123-1412
US

IV. Provider business mailing address

1069 TORREY PINES RD
CHULA VISTA CA
91915-1403
US

V. Phone/Fax

Practice location:
  • Phone: 619-598-0814
  • Fax:
Mailing address:
  • Phone: 619-417-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: