Healthcare Provider Details

I. General information

NPI: 1689464216
Provider Name (Legal Business Name): JORDAN BALDWIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14632 YORBA ST
TUSTIN CA
92780-2554
US

IV. Provider business mailing address

14632 YORBA ST STE B
TUSTIN CA
92780-2554
US

V. Phone/Fax

Practice location:
  • Phone: 949-494-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: