MEDICARE: PAIGE JORDAN DRIVER

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1255284691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE JORDAN DRIVER

Provider Business Mailing Address
First Line	:	7475 EL CAJON BLVD APT 110
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7484
Country	:	US
Telephone Number	:	918-308-0479
Fax Number	:

Provider Business Practice Location Address
First Line	:	7475 EL CAJON BLVD APT 110
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7484
Country	:	US
Telephone Number	:	918-308-0479
Fax Number	:

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ PAIGE JORDAN DRIVER ” Practice Location

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