MEDICARE: AFRICA JORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	1041C0700X	Clinical Social Worker	IC-1679	NV

General Provider Information

NPI Number	:	1073944070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFRICA JORDAN

Provider Business Mailing Address
First Line	:	4055 SPENCER ST STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5250
Country	:	US
Telephone Number	:	702-799-9710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 SPENCER ST STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5250
Country	:	US
Telephone Number	:	702-799-9710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	02/04/2026

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Directions to “ AFRICA JORDAN ” Practice Location

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