Healthcare Provider Details

I. General information

NPI: 1164334124
Provider Name (Legal Business Name): JORDAN MORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 TRUXTUN RD
SAN DIEGO CA
92106-6049
US

IV. Provider business mailing address

6522 AMBROSIA DR APT 5408
SAN DIEGO CA
92124-3137
US

V. Phone/Fax

Practice location:
  • Phone: 619-814-5060
  • Fax:
Mailing address:
  • Phone: 614-285-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: