MEDICARE: AAZHA 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	374J00000X	Doula

General Provider Information

NPI Number	:	1346103967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AAZHA JORDAN

Provider Business Mailing Address
First Line	:	4122 39TH ST APT 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1383
Country	:	US
Telephone Number	:	626-376-3704
Fax Number	:

Provider Business Practice Location Address
First Line	:	4122 39TH ST APT 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1383
Country	:	US
Telephone Number	:	626-376-3704
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ AAZHA JORDAN ” Practice Location

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