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General NPI Number Information
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NPI Number | 1174652598
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Entity Type | Individual
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Provider Name | JORDAN DUNYASHA VIX MSW/LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 349A E AVENUE K6
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City | LANCASTER
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State | CA
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Zip | 93535-4548
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Country | US
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Telephone | 661-974-8400
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Fax | 661-729-2186
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Provider Business Mailing Address
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Address Line | 2010 W AVENUE K # 389
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City | LANCASTER
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State | CA
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Zip | 93536-5229
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Country | US
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Telephone | 661-974-8417
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Fax | 661-729-2186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 20718
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25864
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License Number State | CA
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