Provider Demographics
NPI:1619337250
Name:JORDAN, CYNTHIA BELINDA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BELINDA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29344 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7255
Mailing Address - Country:US
Mailing Address - Phone:951-579-1099
Mailing Address - Fax:951-579-1099
Practice Address - Street 1:29344 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7255
Practice Address - Country:US
Practice Address - Phone:951-579-1099
Practice Address - Fax:951-579-1099
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse