Provider Demographics
NPI:1467667089
Name:JORDAN, LIGIA NOEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LIGIA
Middle Name:NOEMI
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 360657
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0657
Mailing Address - Country:US
Mailing Address - Phone:787-502-8465
Mailing Address - Fax:
Practice Address - Street 1:877 CARR KM1.6
Practice Address - Street 2:CAMINO LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9767
Practice Address - Country:US
Practice Address - Phone:787-760-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10073208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10073OtherPHYSICIAN LICENSE