Provider Demographics
NPI:1437620390
Name:MAKIN, JORDAN ALEXIS
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXIS
Last Name:MAKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 FENTON PKWY APT 213
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4748
Mailing Address - Country:US
Mailing Address - Phone:814-421-5938
Mailing Address - Fax:
Practice Address - Street 1:15615 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2405
Practice Address - Country:US
Practice Address - Phone:858-613-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95157633163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical