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General NPI Number Information
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NPI Number | 1639005986
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Entity Type | Individual
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Provider Name | JORDAN MAX BENJAMIN PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 2251 HOWARD ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4554
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Country | US
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Telephone | 509-520-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 522 36TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-2608
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Country | US
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Telephone | 415-218-2211
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | PARA.ES.60960544
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License Number State | WA
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