Provider Demographics
NPI:1033303151
Name:JORDAN, MARLA ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:ESTHER
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8010
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8010
Mailing Address - Country:US
Mailing Address - Phone:787-316-7963
Mailing Address - Fax:
Practice Address - Street 1:CLINICA EPANOLA
Practice Address - Street 2:BO. BALBOA SECTOR LA QUINTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-832-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0171402084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1033303151OtherTRIPLE-S
PR1033303151OtherTRIPLE-S