Jordan Ambrose Jeremiah
Student in an Organized Health Care Education/Training Program in Los Angeles, CA. Individual provider (NPI-1).
NPI number1104502467
StatusActive
Last updated in NPPESJun 22, 2023
Details
- NPI
- 1104502467
- Entity type
- Individual (NPI-1)
- Name
- Jordan Ambrose Jeremiah
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 22, 2023
- Certification date
- Jun 22, 2023
- Last updated
- Jun 22, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
4063 Whittier Blvd Ste 202Los Angeles, CA 90023-2536
Phone 323-268-2100
Mailing address
14308 Ohio StBaldwin Park, CA 91706-2553
Phone 626-838-4805
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