Healthcare Provider Details

I. General information

NPI: 1083407456
Provider Name (Legal Business Name): ALIA JORDAN MANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD STE C118
MIDVALE UT
84047-5512
US

IV. Provider business mailing address

7526 NAVIGATOR CIR
CARLSBAD CA
92011-5404
US

V. Phone/Fax

Practice location:
  • Phone: 801-792-4867
  • Fax: 866-421-6132
Mailing address:
  • Phone: 760-803-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: