MEDICARE: JORDAN LYNN LOUGHRIN

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	133V00000X	Registered Dietitian	86062890	CA

General Provider Information

NPI Number	:	1255297867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN LYNN LOUGHRIN

Provider Business Mailing Address
First Line	:	74094 CATALINA WAY
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3028
Country	:	US
Telephone Number	:	760-808-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	74094 CATALINA WAY
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3028
Country	:	US
Telephone Number	:	760-808-3284
Fax Number	:	760-808-3284

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

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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