Healthcare Provider Details

I. General information

NPI: 1811418734
Provider Name (Legal Business Name): JORDAN LUCILLE JUPENA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 2
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE FL 2 SUITE A2300
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8595
  • Fax: 415-353-2919
Mailing address:
  • Phone: 415-353-8595
  • Fax: 415-353-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059117
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA65664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: