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General NPI Number Information
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NPI Number | 1396346326
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Entity Type | Individual
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Provider Name | JACOB PAUL JORDAN PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 200 MERCY CIR
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City | OCEANSIDE
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State | CA
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Zip | 92058
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Country | US
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Telephone | 619-277-7348
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 555191
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City | CAMP PENDLETON
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State | CA
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Zip | 92055-5191
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Country | US
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Telephone | 619-277-7348
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810007805
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License Number State | VA
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