Healthcare Provider Details

I. General information

NPI: 1194523712
Provider Name (Legal Business Name): JORDAN SALUMU MASUDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S 400 E APT 13
CEDAR CITY UT
84720-3473
US

IV. Provider business mailing address

334 S 400 E APT 13
CEDAR CITY UT
84720-3473
US

V. Phone/Fax

Practice location:
  • Phone: 513-501-3718
  • Fax: 513-501-3718
Mailing address:
  • Phone: 513-501-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: