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NPI Code Detail

MEDICARE: JORDAN WHITESIDES

MEDICARE: JORDAN WHITESIDES
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
1363LF0000XFamily Nurse Practitioner95037711CA

General Provider Information

NPI Number : 1255293189
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WHITESIDES
Provider Business Mailing Address
First Line : 2635 CAMINO DEL RIO S STE 200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3728
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2635 CAMINO DEL RIO S STE 200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3728
Country : US
Telephone Number : 858-321-3133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ JORDAN WHITESIDES ” Practice Location

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