Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 62508 | CA |
NPI | 1144661075 |
---|---|
Provider Name | Dr. Andrea Elizabeth Jordan |
First Address | Palo Alto, CA 94306-1053 |
Second Address | Palo Alto, CA 94306-1053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 08/07/2013 |