Healthcare Provider Details

I. General information

NPI: 1831790567
Provider Name (Legal Business Name): JORDAN ABAD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 120
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

600 CENTRAL AVE STE C
LAKE ELSINORE CA
92530-2740
US

V. Phone/Fax

Practice location:
  • Phone: 951-695-5144
  • Fax: 951-695-9345
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number299468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: