Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | A30817 | CA |
NPI | 1053474783 |
---|---|
Provider Name | Dr. Wilbert Cornelious Jordan |
First Address | Paramount, CA 90723-5433 |
Second Address | Paramount, CA 90723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2006 |
Last Update Date | 03/07/2018 |