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NPI Code Detail

MEDICARE: MS. JORDAN DUNYASHA VIX MSW/LCSW

MEDICARE: MS. JORDAN DUNYASHA VIX MSW/LCSW
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
1104100000XSocial Worker20718CA
21041C0700XClinical Social Worker25864CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2W2983OTHERCAMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1159510OTHERCAIS SVX LOC #
3HI557ZOTHERCAPTAN

General Provider Information

NPI Number : 1174652598
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JORDAN DUNYASHA VIX MSW/LCSW
Provider Business Mailing Address
First Line : 2010 W AVENUE K # 389
Second Line :
City : LANCASTER
State : CA
Zip : 93536-5229
Country : US
Telephone Number : 661-974-8417
Fax Number : 661-729-2186
Provider Business Practice Location Address
First Line : 349A E AVENUE K6
Second Line :
City : LANCASTER
State : CA
Zip : 93535-4548
Country : US
Telephone Number : 661-974-8400
Fax Number : 661-729-2186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 10/24/2013

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