Provider Demographics
NPI:1356851778
Name:JORDAN, DIANE DELA CRUZ (LVN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:DELA CRUZ
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CITRACADO PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4113
Mailing Address - Country:US
Mailing Address - Phone:760-294-1281
Mailing Address - Fax:760-888-2175
Practice Address - Street 1:1955 CITRACADO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4113
Practice Address - Country:US
Practice Address - Phone:760-294-1281
Practice Address - Fax:760-888-2175
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN682492164X00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953302967Medicaid