Healthcare Provider Details

I. General information

NPI: 1811688948
Provider Name (Legal Business Name): JORDAN JAMES PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 MCBEAN PKWY STE 215
VALENCIA CA
91355-3703
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-753-5464
  • Fax: 661-753-5466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: